1255448155 NPI number — STARLING PHYSICIANS PC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255448155 NPI number — STARLING PHYSICIANS PC

Employer Identification Number (EIN):

Provider Organization Name:

STARLING PHYSICIANS PC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

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:

1255448155

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

03/27/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2110 SILAS DEANE HWY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ROCKY HILL

Provider Business Mailing Address State Name:

CT

Provider Business Mailing Address Postal Code:

06067-2313

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

860-258-3470

Provider Business Mailing Address Fax Number:

860-571-6800

Provider First Line Business Practice Location Address:

300 KENSINGTON AVE

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:

06051-3999

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

860-224-6201

Provider Business Practice Location Address Fax Number:

860-224-6260

Provider Enumeration Date:

08/24/2006

Authorized Official Last Name:

LEBENGER

Authorized Official First Name:

JEFFREY

Authorized Official Middle Name:

D

Authorized Official Title or Position:

CEO

Authorized Official Telephone Number:

908-790-6567

• Taxonomy code: 207KA0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207RG0100X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RP1001X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RR0500X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207X00000X ; 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: "N" .
• Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 004118106 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004195930 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004224846 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 15MRI0155CT01 . This is a "BCBS & BCFP MRI ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 004062394 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004196095 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004214417 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004214425 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004214441 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004214467 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004214483 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004264660 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004214433 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004214475 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004214813 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004214459 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004215324 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 004239655 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".