1679704225 NPI number — MRS. JENNIFER L GIFFUNE RD LDN

Table of content: MRS. JENNIFER L GIFFUNE RD LDN (NPI 1679704225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679704225 NPI number — MRS. JENNIFER L GIFFUNE RD LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIFFUNE
Provider First Name:
JENNIFER
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679704225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
354 BIRNIE AVENUE
Provider Second Line Business Mailing Address:
HCPA
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01107-1109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-733-3470
Provider Business Mailing Address Fax Number:
413-733-4298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
354 BIRNIE AVE
Provider Second Line Business Practice Location Address:
HAMPDEN COUNTY PHYSICIAN ASSOCIATES, LLC
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01107-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-733-3470
Provider Business Practice Location Address Fax Number:
413-733-4298
Provider Enumeration Date:
07/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1132 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000105101 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 42791 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".