1053743625 NPI number — DANIEL ADAM KILHEFNER SUBIDC

Table of content: DANIEL ADAM KILHEFNER SUBIDC (NPI 1053743625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053743625 NPI number — DANIEL ADAM KILHEFNER SUBIDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILHEFNER
Provider First Name:
DANIEL
Provider Middle Name:
ADAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SUBIDC
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:
1053743625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BURNINGTREE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06340-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-514-1905
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WAHOO AVE BLDG 449
Provider Second Line Business Practice Location Address:
BOX 600, NAVAL SUBMARINE BASE NEW LONDON
Provider Business Practice Location Address City Name:
GROTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06349-2324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-514-1905
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2013

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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