1356329742 NPI number — NEW HAVEN SURGICAL ASSOCIATES,PC

Table of content: (NPI 1356329742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356329742 NPI number — NEW HAVEN SURGICAL ASSOCIATES,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HAVEN SURGICAL ASSOCIATES,PC
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:
1356329742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
136 SHERMAN AVE
Provider Second Line Business Mailing Address:
SUITE # 308
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06511-5238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-777-2376
Provider Business Mailing Address Fax Number:
203-777-6916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 SHERMAN AVE
Provider Second Line Business Practice Location Address:
SUITE # 308
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06511-5238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-777-2376
Provider Business Practice Location Address Fax Number:
203-777-6916
Provider Enumeration Date:
01/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AMODEO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-777-2376

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  20049 , 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: 010020049CT01 . This is a "BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: OV3673 . This is a "HELATHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1704128 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C007212 . This is a "CHAMPUS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4266164 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010033084CT01 . This is a "BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4534907 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: NHS101 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: NHS100 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: OV3674 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1704485 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com