1750625869 NPI number — MR. JOHN Q ERWIN L.M.T.

Table of content: MR. JOHN Q ERWIN L.M.T. (NPI 1750625869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750625869 NPI number — MR. JOHN Q ERWIN L.M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERWIN
Provider First Name:
JOHN
Provider Middle Name:
Q
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.M.T.
Provider Gender Code:
M

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:
1750625869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 WEST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06043-7711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-604-2533
Provider Business Mailing Address Fax Number:
860-647-8487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 SEYMOUR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06102-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-545-4444
Provider Business Practice Location Address Fax Number:
860-545-4311
Provider Enumeration Date:
11/15/2012

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: 225700000X , with the licence number:  004967 , 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)