1588977797 NPI number — UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE

Table of content: (NPI 1588977797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588977797 NPI number — UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE
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:
1588977797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
357 BRITTANY FARMS RD APT H322
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06053-1102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-679-8694
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
263 FARMINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06030-5215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-679-3958
Provider Business Practice Location Address Fax Number:
860-679-1307
Provider Enumeration Date:
07/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SCHICK
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF GRADUATE MEDICAL EDUCAT
Authorized Official Telephone Number:
860-679-2147

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  047478 , 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: 150722 . This is a "ABFM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 047478 . This is a "LISENSURE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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