1316085319 NPI number — TOWN OF MANSFIELD DEPARTMENT OF EDUCATION

Table of content: DR. JOHN ERIC RENYE DDS (NPI 1942377007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316085319 NPI number — TOWN OF MANSFIELD DEPARTMENT OF EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF MANSFIELD DEPARTMENT OF EDUCATION
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:
1316085319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 SOUTH EAGLEVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STORRS MANSFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06268-2574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-429-3350
Provider Business Mailing Address Fax Number:
860-429-6863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 SPRING HILL RD
Provider Second Line Business Practice Location Address:
MANSFIELD MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
STORRS MANSFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06268-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-429-9341
Provider Business Practice Location Address Fax Number:
860-429-1020
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LECLERC
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DIRECTOR OF SPECIAL EDUCATION/SUPPO
Authorized Official Telephone Number:
860-429-3353

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  004097334 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004097334 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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