1467571893 NPI number — CITY OF BRIDGEPORT HEALTH DEPT. SCHOOL BASED HEALTH CENTER

Table of content: MISS JULIA JUANITA ABRAMS MAOM (NPI 1508276510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467571893 NPI number — CITY OF BRIDGEPORT HEALTH DEPT. SCHOOL BASED HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BRIDGEPORT HEALTH DEPT. SCHOOL BASED HEALTH CENTER
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:
6
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:
1467571893
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:
752 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06608-2335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-572-7052
Provider Business Mailing Address Fax Number:
203-332-5641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1734 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06610-2763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-576-8213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
MARIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF HEALTH
Authorized Official Telephone Number:
203-576-7680

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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