1013447523 NPI number — MR. MUKHTAR M NALADO LADC

Table of content: MR. MUKHTAR M NALADO LADC (NPI 1013447523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013447523 NPI number — MR. MUKHTAR M NALADO LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NALADO
Provider First Name:
MUKHTAR
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LADC
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:
1013447523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 LONG WHARF DR STE 321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06511-5991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-781-4600
Provider Business Mailing Address Fax Number:
203-781-4624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
495 CONGRESS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06519-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-781-4600
Provider Business Practice Location Address Fax Number:
203-781-4624
Provider Enumeration Date:
06/16/2017

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:  001238 , 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: 008022622 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004082260 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008073258 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008001325 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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