1316281488 NPI number — NATURAL FAMILY HEALTH & INTEGRATIVE MEDICINE, LLC

Table of content: DR. ROBERT NICHOLAS REYNOLDS D.M.D (NPI 1790127009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316281488 NPI number — NATURAL FAMILY HEALTH & INTEGRATIVE MEDICINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATURAL FAMILY HEALTH & INTEGRATIVE MEDICINE, LLC
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:
1316281488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 W BROAD ST
Provider Second Line Business Mailing Address:
LOWER LEVEL
Provider Business Mailing Address City Name:
PAWCATUCK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06379-1831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-495-5688
Provider Business Mailing Address Fax Number:
860-496-5687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W BROAD ST
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
PAWCATUCK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06379-1831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-495-5688
Provider Business Practice Location Address Fax Number:
860-496-5687
Provider Enumeration Date:
11/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NOE
Authorized Official First Name:
JODY
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
NATUROPATHIC PHYSICIAN
Authorized Official Telephone Number:
860-495-5688

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  000411 , 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)





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