1558326991 NPI number — EASTERN CONNECTICUT PATHOLOGY CONSULTANTS, PC

Table of content: (NPI 1558326991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558326991 NPI number — EASTERN CONNECTICUT PATHOLOGY CONSULTANTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN CONNECTICUT PATHOLOGY CONSULTANTS, PC
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:
1558326991
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:
PO BOX 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06501-0206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-397-8000
Provider Business Mailing Address Fax Number:
203-389-1540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 HAYNES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06040-4131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-647-6487
Provider Business Practice Location Address Fax Number:
860-647-6447
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'NEILL
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
860-647-6487

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , 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: 500HBL161CT01 . This is a "BLUE CROSS GROUP #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C009784 . This is a "CHAMPUS TRICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: OR4388 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4126521 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76164901 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 500HBL161CT02 . This is a "BLUE CROSS GRP ROCKVILLE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: W1H29 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1104296 . This is a "UHC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: A524580 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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