1326371253 NPI number — CONNECTICUT HOLISTIC AND INTEGRATIVE MEDICINE

Table of content: (NPI 1326371253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326371253 NPI number — CONNECTICUT HOLISTIC AND INTEGRATIVE MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT HOLISTIC AND INTEGRATIVE MEDICINE
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:
CHAIM
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:
1326371253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1057 POQUONNOCK ROAD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
GROTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06340-6630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-445-2130
Provider Business Mailing Address Fax Number:
860-446-0883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1057 POQUONNOCK ROAD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
GROTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06340-6630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-445-2130
Provider Business Practice Location Address Fax Number:
860-446-0883
Provider Enumeration Date:
09/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MURRAY
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
RUTH
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
860-445-2130

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  031252 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN000126 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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