1104581081 NPI number — WHOLISTIC PERSPECTIVE

Table of content: (NPI 1104581081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104581081 NPI number — WHOLISTIC PERSPECTIVE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHOLISTIC PERSPECTIVE
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:
WHOLISTIC PERSPECTIVE
Provider Other Organization Name Type Code:
4
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:
1104581081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 W JOHNSON AVE STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESHIRE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06410-4532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-398-9627
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 W JOHNSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESHIRE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06410-4531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-398-9627
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BHARDWAJ
Authorized Official First Name:
ESHA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
860-398-9627

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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