1730120494 NPI number — PRIYA P ROY MD

Table of content: PRIYA P ROY MD (NPI 1730120494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730120494 NPI number — PRIYA P ROY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROY
Provider First Name:
PRIYA
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROY
Provider Other First Name:
PRIYANKA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1730120494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 KENSINGTON AVE
Provider Second Line Business Mailing Address:
GROVE HILL MEDICAL CENTER
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06051-3916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-801-6759
Provider Business Mailing Address Fax Number:
860-348-4873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 KENSINGTON AVE
Provider Second Line Business Practice Location Address:
GROVE HILL MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEW BRITAIN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06051-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-832-8150
Provider Business Practice Location Address Fax Number:
860-348-4873
Provider Enumeration Date:
06/10/2006

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: 208M00000X , with the licence number:  047089 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 047089 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1596801 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1544939 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1012114140005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184635 . This is a "UNISON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20051965 . This is a "AMERIHEALTH MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50059750 . This is a "CBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2274055000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".