1750468963 NPI number — CONNECTICUT NEUROLOGICAL SPECIALIST, LLC

Table of content: (NPI 1750468963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750468963 NPI number — CONNECTICUT NEUROLOGICAL SPECIALIST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT NEUROLOGICAL SPECIALIST, LLC
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:
CNS, LLC
Provider Other Organization Name Type Code:
3
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:
1750468963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 LEWIS AVE STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06451-2121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-630-1000
Provider Business Mailing Address Fax Number:
203-413-3333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 LEWIS AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MERIDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06451-2121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-630-1000
Provider Business Practice Location Address Fax Number:
203-413-3333
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAMI
Authorized Official First Name:
HAMID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
203-630-1000

Provider Taxonomy Codes

  • Taxonomy code: 2084N0008X , with the licence number:  042289 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 042289 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084V0102X , with the licence number: 042289 , 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: 1470133 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 042289 . This is a "CT STATE LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 301000 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 042289 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1750468963 . This is a "MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V6461 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 5488264 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3721896 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010042289CT04 . This is a "ANTHEM BC BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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