1154308211 NPI number — MS. ELIZABETH S FREEDMAN MD

Table of content: MS. ELIZABETH S FREEDMAN MD (NPI 1154308211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154308211 NPI number — MS. ELIZABETH S FREEDMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEDMAN
Provider First Name:
ELIZABETH
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1154308211
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:
13 CHURCH RD
Provider Second Line Business Mailing Address:
PO BOX 518
Provider Business Mailing Address City Name:
EAST GRANBY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06026-0518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-653-4526
Provider Business Mailing Address Fax Number:
860-653-5209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST GRANBY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06026-0518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-653-4526
Provider Business Practice Location Address Fax Number:
860-653-5307
Provider Enumeration Date:
12/29/2005

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: 207Q00000X , with the licence number:  037507 , 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: 001375072 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010037507CT09 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0V8892V . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7308182 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 037507 . This is a "CT" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2195400 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6609B9002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com