1912286295 NPI number — MARIA ROSE LONGOBARDI HAGUE PT

Table of content: MARIA ROSE LONGOBARDI HAGUE PT (NPI 1912286295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912286295 NPI number — MARIA ROSE LONGOBARDI HAGUE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONGOBARDI HAGUE
Provider First Name:
MARIA
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LONGOBARDI
Provider Other First Name:
MARIA
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912286295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 WASHINGTON AVE FL 1-A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06518-3267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-865-6784
Provider Business Mailing Address Fax Number:
203-865-6788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 COMMERCE PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06460-3551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-878-0479
Provider Business Practice Location Address Fax Number:
203-466-8527
Provider Enumeration Date:
08/04/2011

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: 225100000X , with the licence number:  005722 , 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)