1144417627 NPI number — EVELYN V CASAS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144417627 NPI number — EVELYN V CASAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVELYN V CASAS MD
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:
6
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:
1144417627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 MORGAN ST
Provider Second Line Business Mailing Address:
#8
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06905-5433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-353-1123
Provider Business Mailing Address Fax Number:
203-353-1132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 MORGAN ST
Provider Second Line Business Practice Location Address:
#8
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06905-5433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-353-1123
Provider Business Practice Location Address Fax Number:
203-353-1132
Provider Enumeration Date:
09/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MELLIJOR-CASAS
Authorized Official First Name:
EVELYN
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
203-353-1123

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001348871 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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