1467544239 NPI number — CONNECTICUT SURGEONS, LLC

Table of content: (NPI 1467544239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467544239 NPI number — CONNECTICUT SURGEONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT SURGEONS, LLC
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:
1467544239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 WOODLAND ST
Provider Second Line Business Mailing Address:
SECOND FLOOR
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-6871
Provider Business Mailing Address Fax Number:
860-714-6888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 WOODLAND ST
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-7447
Provider Business Practice Location Address Fax Number:
860-727-0242
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAOUD
Authorized Official First Name:
IBRAHIM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-714-6871

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1487663118 . This is a "HONORE NPI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V5964 . This is a "HONORE HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1200451012 . This is a "BARBA CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 622478 . This is a "BARBA CTCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010033106CT03 . This is a "BARBA BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004245602 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2V6493 . This is a "BARBA HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3962260 . This is a "BARBA AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001331066 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 400002988CT01 . This is a "HONORE BCBS ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3887114 . This is a "BARBA OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 00133106602 . This is a "BARBA BCFP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1679581359 . This is a "BARBA NPI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com