1710447222 NPI number — VASSAR HEALTH QUEST MEDICAL PRACTICE OF CONNECTICUT INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710447222 NPI number — VASSAR HEALTH QUEST MEDICAL PRACTICE OF CONNECTICUT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASSAR HEALTH QUEST MEDICAL PRACTICE OF CONNECTICUT 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:
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:
1710447222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1351 ROUTE 55 STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGRANGEVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12540-5128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-475-9661
Provider Business Mailing Address Fax Number:
845-475-9938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 HOSPITAL HILL RD STE 1400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06069-2095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-364-7029
Provider Business Practice Location Address Fax Number:
860-364-7079
Provider Enumeration Date:
03/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
LOOMIS
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
845-475-9661

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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