1306837323 NPI number — MS. JO-ANN BERGERON POLSKY BS, MPH, RD

Table of content: MS. REBECCA LYNN MANFREDONIA (NPI 1669183760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306837323 NPI number — MS. JO-ANN BERGERON POLSKY BS, MPH, RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLSKY
Provider First Name:
JO-ANN
Provider Middle Name:
BERGERON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BS, MPH, RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERGERON
Provider Other First Name:
JO-ANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306837323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
593 EDDY ST
Provider Second Line Business Mailing Address:
RHODE ISLAND HOSPITAL POB 334
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-4923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-444-4422
Provider Business Mailing Address Fax Number:
401-444-4416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
593 EDDY ST
Provider Second Line Business Practice Location Address:
RHODE ISLAND HOSPITAL POB 334
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-4923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-444-4422
Provider Business Practice Location Address Fax Number:
401-444-4416
Provider Enumeration Date:
10/31/2005

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: 133N00000X , with the licence number:  LDN00151 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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