1881635712 NPI number — CONNECTICUT EAR, NOSE & THROAT, SINUS & ALLERGY SPECIALISTS, P.C.

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 1881635712 NPI number — CONNECTICUT EAR, NOSE & THROAT, SINUS & ALLERGY SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT EAR, NOSE & THROAT, SINUS & ALLERGY SPECIALISTS, P.C.
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:
6
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:
1881635712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 W MAIN ST
Provider Second Line Business Mailing Address:
ONE EXCHANGE PLACE BLDG-3RD FLOOR
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06702-2013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-574-3777
Provider Business Mailing Address Fax Number:
203-755-1708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 W MAIN ST
Provider Second Line Business Practice Location Address:
ONE EXCHANGE PLACE BLDG-3RD FLOOR
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06702-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-574-3777
Provider Business Practice Location Address Fax Number:
203-527-4008
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CIPRIANO
Authorized Official First Name:
DANA
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
203-574-3777

Provider Taxonomy Codes

  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004239077 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004194627 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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