1306851050 NPI number — DERMATOLOGY ASSOCIATES OF WESTERN CONNECTICUT, PC

Table of content: MS. KATE GALLAGHER LMFT LPC (NPI 1699842542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306851050 NPI number — DERMATOLOGY ASSOCIATES OF WESTERN CONNECTICUT, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMATOLOGY ASSOCIATES OF WESTERN CONNECTICUT, PC
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:
1306851050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 MOUNT PLEASANT RD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06470-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-792-4151
Provider Business Mailing Address Fax Number:
203-792-4155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 MOUNT PLEASANT RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06470-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-792-4151
Provider Business Practice Location Address Fax Number:
203-792-4155
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZALKA
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
SENIOR PARTNER
Authorized Official Telephone Number:
203-792-4151

Provider Taxonomy Codes

  • Taxonomy code: 207NS0135X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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