1639286362 NPI number — MRS. CARMEN IRIS IPPOLITO CRNA

Table of content: MRS. CARMEN IRIS IPPOLITO CRNA (NPI 1639286362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639286362 NPI number — MRS. CARMEN IRIS IPPOLITO CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IPPOLITO
Provider First Name:
CARMEN
Provider Middle Name:
IRIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1639286362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 WOODMERE CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-248-6009
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1423 CHAPEL
Provider Second Line Business Practice Location Address:
ST RAPHAEL HOSPITAL ANESTHESIA ASSOCIATES
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-789-3538
Provider Business Practice Location Address Fax Number:
203-865-2983
Provider Enumeration Date:
08/25/2006

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: 367500000X , with the licence number:  APRN000133 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: RNE35834 , 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)





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