1275511958 NPI number — MRS. KAREN ANNE COCCOLUTO APRN BC PC

Table of content: RACHELI ATTIA (NPI 1811316441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275511958 NPI number — MRS. KAREN ANNE COCCOLUTO APRN BC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COCCOLUTO
Provider First Name:
KAREN
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN BC PC
Provider Gender Code:
F

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:
1275511958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2528 MAIN POLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01096-9602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-369-4746
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 STATE ST
Provider Second Line Business Practice Location Address:
#206
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01060-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-320-7594
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2006

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: 364SP0808X , with the licence number:  108491 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2143127 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: PN0818 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 131404000 . This is a "MAGELLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1893289 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 467761 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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