1760473946 NPI number — JEANNINE M TONETTI NP

Table of content: JEANNINE M TONETTI NP (NPI 1760473946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760473946 NPI number — JEANNINE M TONETTI NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TONETTI
Provider First Name:
JEANNINE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1760473946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1690
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01202-1690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-499-8568
Provider Business Mailing Address Fax Number:
413-499-8580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 NORTH ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-499-8570
Provider Business Practice Location Address Fax Number:
413-499-8565
Provider Enumeration Date:
11/04/2005

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: 363LX0001X , with the licence number:  171676 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NP5089 . This is a "HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33167 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: 789601 . This is a "MVP SELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: NP5089 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0703877 . This is a "WELFARE MASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0703877 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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