1295807147 NPI number — ROBERT J NARUCKI M.A., CP

Table of content: ROBERT J NARUCKI M.A., CP (NPI 1295807147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295807147 NPI number — ROBERT J NARUCKI M.A., CP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NARUCKI
Provider First Name:
ROBERT
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., CP
Provider Gender Code:
M

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:
1295807147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
899 MAIN ST
Provider Second Line Business Mailing Address:
SUITE ONE
Provider Business Mailing Address City Name:
COLCHESTER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05446-4420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-872-7645
Provider Business Mailing Address Fax Number:
802-872-2795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
899 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
COLCHESTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05446-4420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-872-7645
Provider Business Practice Location Address Fax Number:
802-872-2795
Provider Enumeration Date:
11/15/2006

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: 103TC2200X , with the licence number:  047-0000738 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 047-0000738 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1295807147 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 644443 . This is a "VALUEOPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9543568 . This is a "AETNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 2115240 . This is a "FIRST HEALTH" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 200229625 . This is a "CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2115240 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3009290 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000466088 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1018501 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2599445 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 644443 . This is a "VALUEOPTIONS MILITARY ONESOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1295807147 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 200229625 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9543568 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3009290 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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