1275569782 NPI number — NEW ENGLAND MOLECULAR IMAGING, LLC

Table of content: (NPI 1275569782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275569782 NPI number — NEW ENGLAND MOLECULAR IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ENGLAND MOLECULAR IMAGING, 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:
1275569782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18201 VON KARMAN AVE STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92612-1176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-544-3215
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 TSIENNETO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-537-1380
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KASSA
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VP
Authorized Official Telephone Number:
904-300-2777

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  01601 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 800942 . This is a "HARVARD PILGRIM HLTH CARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 694993 . This is a "TUFTS/SECURE HORIZONS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3962939 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: P00302999 . This is a "RR MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com