1003813965 NPI number — DENNIS J KOBYLARZ M.D.

Table of content: DENNIS J KOBYLARZ M.D. (NPI 1003813965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003813965 NPI number — DENNIS J KOBYLARZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOBYLARZ
Provider First Name:
DENNIS
Provider Middle Name:
J
Provider Name Prefix Text:
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:
1003813965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 970
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANAAN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06018-0970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-824-0753
Provider Business Mailing Address Fax Number:
860-824-4448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 GRANITE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANAAN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06018-0970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-824-0753
Provider Business Practice Location Address Fax Number:
860-824-4448
Provider Enumeration Date:
07/06/2005

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: 207Q00000X , with the licence number:  027736 , 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: 054714 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3003621 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P3296700 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000026702 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 001277367 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010017975 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 081142 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2V5878 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0119144 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13644 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: A21057 . This is a "MEDICARE MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: A67899 . This is a "HARVARD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 010027736CT01 . This is a "BLUE CROSS BLUE SHIEL CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080001602 . This is a "MEDICARE CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 366275 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 779997 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: RO1115 . This is a "BLUE CROSS BLUE SHIELD MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5996764 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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