1942329685 NPI number — DR. WILMA JOAN EZEKOWITZ PH.D

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942329685 NPI number — DR. WILMA JOAN EZEKOWITZ PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EZEKOWITZ
Provider First Name:
WILMA
Provider Middle Name:
JOAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D
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:
1942329685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
295 WASHINGTON AVE
Provider Second Line Business Mailing Address:
STE 11S
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06518-3025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-230-0824
Provider Business Mailing Address Fax Number:
203-248-5360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
STE 11S
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06518-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-230-0824
Provider Business Practice Location Address Fax Number:
203-287-9502
Provider Enumeration Date:
03/27/2007

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: 103TC0700X , with the licence number:  001770 , 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)





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