1205125010 NPI number — CAROLINE L UGOLYN APRN

Table of content: CAROLINE L UGOLYN APRN (NPI 1205125010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205125010 NPI number — CAROLINE L UGOLYN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UGOLYN
Provider First Name:
CAROLINE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUKE
Provider Other First Name:
CAROLINE
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205125010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
761 MAIN AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06851-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-838-4000
Provider Business Mailing Address Fax Number:
203-845-9535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 OLD KINGS HWY N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARIEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06820-4609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-662-9333
Provider Business Practice Location Address Fax Number:
203-662-9313
Provider Enumeration Date:
04/01/2011

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: 163WM0705X , with the licence number:  094032 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 094032 , 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)