1336256908 NPI number — MR. ARLIN DEBOER PT

Table of content: MR. ARLIN DEBOER PT (NPI 1336256908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336256908 NPI number — MR. ARLIN DEBOER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEBOER
Provider First Name:
ARLIN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1336256908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06757-0034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-927-4559
Provider Business Mailing Address Fax Number:
860-927-3352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64 MAPLE ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06757-0034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-927-4559
Provider Business Practice Location Address Fax Number:
860-927-3352
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  004702 , 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: 575838 . This is a "CONNECTICARE PROVIDER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 15901 . This is a "CIGNA ORTHONET PROVIDER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2057224 . This is a "OXFORD OUT OF NETWORK PRO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2288136 . This is a "AETNA PROVIDER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 64-04275 . This is a "UNITED HEALTH CARE PROVID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: OV6316 . This is a "HEALTH NET PROVIDER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: QA6291 . This is a "EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 437034 . This is a "MVP PROVIDER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0800004702CT01 . This is a "ANTHEM BC/BS PROVIDER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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