1184666430 NPI number — DR. ALICJA JADWIGA HARBUT III MD

Table of content: DR. ALICJA JADWIGA HARBUT III MD (NPI 1184666430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184666430 NPI number — DR. ALICJA JADWIGA HARBUT III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARBUT
Provider First Name:
ALICJA
Provider Middle Name:
JADWIGA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
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:
HARBUT
Provider Other First Name:
ALICJA
Provider Other Middle Name:
JADWIGA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184666430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 CLINTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06053-3509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-223-4146
Provider Business Mailing Address Fax Number:
860-223-6908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 CLINTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRITAIN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06053-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-223-4146
Provider Business Practice Location Address Fax Number:
860-223-6908
Provider Enumeration Date:
06/12/2006

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: 207QA0505X , with the licence number:  022670 , 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)





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