1356381156 NPI number — MRS. JULIANNA THERESA REIMOLD PT

Table of content: MRS. JULIANNA THERESA REIMOLD PT (NPI 1356381156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356381156 NPI number — MRS. JULIANNA THERESA REIMOLD PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REIMOLD
Provider First Name:
JULIANNA
Provider Middle Name:
THERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DINSMORE
Provider Other First Name:
JULIANNA
Provider Other Middle Name:
THERESA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1356381156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1377 MOTOR PKWY
Provider Second Line Business Mailing Address:
STE 307
Provider Business Mailing Address City Name:
ISLANDIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11749-5258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-580-5200
Provider Business Mailing Address Fax Number:
631-580-5222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 CHASE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708-3346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-754-2266
Provider Business Practice Location Address Fax Number:
203-591-8680
Provider Enumeration Date:
06/08/2006

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:  003988 , 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: 004265769 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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