1255566543 NPI number — PARADIGM HEALTHCARE CENTER OF TORRINGTON, LLC

Table of content: (NPI 1255566543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255566543 NPI number — PARADIGM HEALTHCARE CENTER OF TORRINGTON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARADIGM HEALTHCARE CENTER OF TORRINGTON, LLC
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:
1255566543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 FERN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06790-3807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-482-7668
Provider Business Mailing Address Fax Number:
860-496-7815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 FERN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06790-3807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-482-7668
Provider Business Practice Location Address Fax Number:
860-496-7815
Provider Enumeration Date:
05/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ZISKIN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MEMBER/VICE PRESIDENT
Authorized Official Telephone Number:
860-729-6268

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PENDING , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 075105 . This is a "MEDICARE BY ASSIGNMENT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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