1508874470 NPI number — HIMAL THAKAR MD

Table of content: HIMAL THAKAR MD (NPI 1508874470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508874470 NPI number — HIMAL THAKAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THAKAR
Provider First Name:
HIMAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAL
Provider Other First Name:
HIMAL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508874470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 STRAITS TPKE
Provider Second Line Business Mailing Address:
SUITE #201
Provider Business Mailing Address City Name:
MIDDLEBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06762-1836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-573-9512
Provider Business Mailing Address Fax Number:
203-568-2904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64 ROBBINS ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708-2613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-573-6263
Provider Business Practice Location Address Fax Number:
203-573-6030
Provider Enumeration Date:
08/04/2006

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: 207RI0200X , with the licence number:  2004033200 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 046713 , 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: 198531 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7614689 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 207313305 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 704270 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".




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