1790781672 NPI number — DR. FRANK J GERRATANA M.D.

Table of content: DR. FRANK J GERRATANA M.D. (NPI 1790781672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790781672 NPI number — DR. FRANK J GERRATANA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERRATANA
Provider First Name:
FRANK
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1790781672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
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:
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:
860-832-4666
Provider Business Mailing Address Fax Number:
860-348-4931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73 CEDAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRITAIN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06052-1390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-832-4666
Provider Business Practice Location Address Fax Number:
860-348-4931
Provider Enumeration Date:
06/24/2005

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: 207X00000X , with the licence number:  017439 , 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: 010017439CT01 . This is a "BCBS N BCFP PROV ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 01027439 . This is a "CIGNA PROV ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060112 . This is a "HEALTH NET PROV ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1255448155 . This is a "GHMCGROUP NPI AFFILIATION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P369862 . This is a "OXFORD PROV ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004214425 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001174390 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 275569 . This is a "WELLCARE MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1255448155 . This is a "GHMC GRP NPI ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060291 . This is a "CONNECTICARE PROV ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 84073 . This is a "AETNA REF ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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