1871681619 NPI number — JAY R POLINER M.D.

Table of content: JAY R POLINER M.D. (NPI 1871681619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871681619 NPI number — JAY R POLINER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLINER
Provider First Name:
JAY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1871681619
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:
200 RETREAT AVE
Provider Second Line Business Mailing Address:
RESEARCH BUILDING, 8TH FLOOR
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06106-3309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-545-7596
Provider Business Mailing Address Fax Number:
860-549-2215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 ELLINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06108-1176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-569-8800
Provider Business Practice Location Address Fax Number:
860-291-2788
Provider Enumeration Date:
10/10/2006

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: 207Q00000X , with the licence number:  031260 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2083P0500X , with the licence number: 031260 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





Copyright © 2007-2025 www.npivalidator.com