1649405887 NPI number — APT FOUNDATION INC

Table of content: (NPI 1649405887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649405887 NPI number — APT FOUNDATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APT FOUNDATION INC
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:
LEGION AVENUE CLINIC
Provider Other Organization Name Type Code:
3
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:
1649405887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 LONG WHARF DR
Provider Second Line Business Mailing Address:
SUITE 321
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06511-5991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-781-4600
Provider Business Mailing Address Fax Number:
203-781-4624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
495 CONGRESS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06519-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-781-4740
Provider Business Practice Location Address Fax Number:
203-781-4751
Provider Enumeration Date:
05/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MADDEN
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
203-781-4600

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  0476 , 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: 008022622 . This is a "LEGION/MEDICAID/MH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008037391 . This is a "SHACKELL MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008050785 . This is a "DROZD MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008070113 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001302497 . This is a "SHI MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008003745 . This is a "DESROSIERS MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001423136 . This is a "TETRAULT MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008069472 . This is a "POTWARDOWSKI MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008038052 . This is a "NODELMAN MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008038037 . This is a "EGGERT MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008045323 . This is a "GARCIA MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008066293 . This is a "MARDAM BEY MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008061961 . This is a "SMALL-OIE MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001340132 . This is a "SAVAGE MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008038053 . This is a "ROEHRICH MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008048393 . This is a "BARRY MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008050854 . This is a "BUTNER MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008053091 . This is a "BUTNER MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001218107 . This is a "SCHOTTENFELD MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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