1982755302 NPI number — RUDOLPH J SIMARI JR.

Table of content: RUDOLPH J SIMARI JR. (NPI 1982755302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982755302 NPI number — RUDOLPH J SIMARI JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMARI
Provider First Name:
RUDOLPH
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
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:
1982755302
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:
250 SECOND HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEWATER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06752-1031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-740-1700
Provider Business Mailing Address Fax Number:
860-354-2969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 SECOND HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEWATER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06752-1031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-740-1700
Provider Business Practice Location Address Fax Number:
860-354-2969
Provider Enumeration Date:
01/13/2007

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: 101YA0400X , with the licence number:  000513 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YP2500X , with the licence number: 000007 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: P354065 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 258639 . This is a "MHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 240000007CT02 . This is a "ANTHEM B" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 20326 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 240000007CT07 . This is a "LPC T" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 240000007CT06 . This is a "LPC W" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 466903 . This is a "VALUEOPTIONS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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