1407984222 NPI number — SOUTHBURY MEDICAL ASSOCIATES, LLP

Table of content: MORGAN SIROTA BEHAVIOR TECHNICIAN (NPI 1861114746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407984222 NPI number — SOUTHBURY MEDICAL ASSOCIATES, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHBURY MEDICAL ASSOCIATES, LLP
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:
1407984222
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:
22 OLD WATERBURY ROAD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SOUTHBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-264-6503
Provider Business Mailing Address Fax Number:
203-262-1430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 OLD WATERBURY RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SOUTHBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06488-3848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-264-6503
Provider Business Practice Location Address Fax Number:
203-262-1430
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PANNILL
Authorized Official First Name:
FITZHUGH
Authorized Official Middle Name:
C
Authorized Official Title or Position:
FINANCIAL PARTNER
Authorized Official Telephone Number:
203-264-6503

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)





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