1710048111 NPI number — CATHLEEN ANNE ALEX AU.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710048111 NPI number — CATHLEEN ANNE ALEX AU.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ALEX

Provider First Name:

CATHLEEN

Provider Middle Name:

ANNE

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

AU.D.

Provider Gender Code:

F

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:

1710048111

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/02/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2 POMPERAUG OFFICE PARK

Provider Second Line Business Mailing Address:

SUITE 307

Provider Business Mailing Address City Name:

SOUTHBURY

Provider Business Mailing Address State Name:

CT

Provider Business Mailing Address Postal Code:

06488-2288

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

203-264-8201

Provider Business Mailing Address Fax Number:

203-264-8201

Provider First Line Business Practice Location Address:

2 POMPERAUG OFFICE PARK

Provider Second Line Business Practice Location Address:

SUITE 307

Provider Business Practice Location Address City Name:

SOUTHBURY

Provider Business Practice Location Address State Name:

CT

Provider Business Practice Location Address Postal Code:

06488-2288

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

203-264-8201

Provider Business Practice Location Address Fax Number:

203-264-8201

Provider Enumeration Date:

12/12/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 237600000X , with the licence number:  109 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 231H00000X , with the licence number: 109 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 231HA2400X , with the licence number: 109 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 231HA2500X , with the licence number: 109 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 4048674 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 001376523-001 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 724745 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 0123218 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 730000109CT01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: OR2817 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: P442727 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 4048864 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".