1972556165 NPI number — HARTFORD HEADACHE CENTER, LLC

Table of content: BRANDI MICHELLE HUF PHARMD (NPI 1861798712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972556165 NPI number — HARTFORD HEADACHE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARTFORD HEADACHE CENTER, LLC
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:
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:
1972556165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 MAIN STREET
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
EAST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-895-3133
Provider Business Mailing Address Fax Number:
860-895-3131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
EAST HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-895-3133
Provider Business Practice Location Address Fax Number:
860-895-3131
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BILCHIK
Authorized Official First Name:
TANYA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR HARTFORD HEADACHE CENTER
Authorized Official Telephone Number:
860-895-3133

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C03156 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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