1306878590 NPI number — NEW BRITAIN FAMILY PRACTICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306878590 NPI number — NEW BRITAIN FAMILY PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW BRITAIN FAMILY PRACTICE
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:
NEW BRITAIN FAMILY PRACTICE LLC
Provider Other Organization Name Type Code:
5
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:
1306878590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
952 TOWN CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18901-5182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-230-1990
Provider Business Mailing Address Fax Number:
215-230-7305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
952 TOWN CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRITAIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18901-5182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-230-1990
Provider Business Practice Location Address Fax Number:
215-230-7305
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PORRINO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-230-1990

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  05009240L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1015340680001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1520212 . This is a "PENNSYLVANIA BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2215053001 . This is a "KEYSTONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com