1376574947 NPI number — INTERNAL MEDICINE ASSOCIATES OF DARIEN, P.C.

Table of content: (NPI 1376574947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376574947 NPI number — INTERNAL MEDICINE ASSOCIATES OF DARIEN, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE ASSOCIATES OF DARIEN, P.C.
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:
1376574947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 OLD KINGS HWY S
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DARIEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06820-4523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-655-4484
Provider Business Mailing Address Fax Number:
203-656-0701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 OLD KINGS HWY S
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DARIEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06820-4523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-655-4484
Provider Business Practice Location Address Fax Number:
203-656-0701
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEGUS
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
203-655-4484

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001222256 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001396614 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001355785 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110171891 . This is a "RAILROAD MEDICARE PROVIDE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 110220758 . This is a "RAILROAD MEDICARE PROVIDE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001172683 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001236066 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110144792 . This is a "RAILROAD MEDICARE PROVIDE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 110218045 . This is a "RAILROAD MEDICARE NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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