1235588997 NPI number — RICHARD J LAVOIE

Table of content: (NPI 1235588997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235588997 NPI number — RICHARD J LAVOIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD J LAVOIE
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:
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:
1235588997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 LAFAYETTE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06360-3407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-887-1316
Provider Business Mailing Address Fax Number:
860-887-1418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 LAFAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06360-3407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-887-1316
Provider Business Practice Location Address Fax Number:
860-887-1418
Provider Enumeration Date:
06/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LAVOIE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SOLE PROPIETOR
Authorized Official Telephone Number:
860-887-1316

Provider Taxonomy Codes

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

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

  • Identifier: 001256130 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com