1063626547 NPI number — ABILIS

Table of content: MS. RACHEL ANNE FRUGE RN (NPI 1619280583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063626547 NPI number — ABILIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABILIS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1063626547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 GLENVILLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06831-4140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-324-1880
Provider Business Mailing Address Fax Number:
203-324-4390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 SUMMER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06905-5530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-324-1880
Provider Business Practice Location Address Fax Number:
203-324-4390
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MUSTAKAS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SPECIALIST
Authorized Official Telephone Number:
203-531-1880

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004186012 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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