1700105145 NPI number — DR THOMAS J DELUCA AND DR ANTHONY C MARCIANO AND ASSOCIATES P C

Table of content: (NPI 1700105145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700105145 NPI number — DR THOMAS J DELUCA AND DR ANTHONY C MARCIANO AND ASSOCIATES P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR THOMAS J DELUCA AND DR ANTHONY C MARCIANO AND ASSOCIATES P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1700105145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7015
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROSPECT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06712-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-758-4447
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 WATERBURY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPECT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06712-1218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-758-4447
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MARCIANO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
203-758-4447

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  CT2543 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: CT784 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 731890 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004208890 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 090000688CT02 . This is a "BLUE CROSS BLUE SHIELD FEP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 090000784CT01 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 410014504 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7760933012 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2391686 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004024378 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 090000688CT02 . This is a "BLUE CROSS FEP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0V8126 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0V0487 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2380911 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 410043547 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0502410001 . This is a "DME MAC JURISDICTION A" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 090002543CT03 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P384390 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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