1982734653 NPI number — PHILIP M PERRINO P.C.

Table of content: (NPI 1982734653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982734653 NPI number — PHILIP M PERRINO P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIP M PERRINO 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:
ROYAL VISION ASSOCIATES OR DURHAM FAMILY EYE CARE
Provider Other Organization Name Type Code:
3
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:
1982734653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 CHAPEL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06510-3001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-865-6727
Provider Business Mailing Address Fax Number:
203-865-8040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 CHAPEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06510-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-865-6727
Provider Business Practice Location Address Fax Number:
203-865-8040
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PERRINO
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
203-865-6727

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  002286 , 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)

  • Identifier: OV5752 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P1003065 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 910087 . This is a "BLOCK VISION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 183826 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 090002286CT06 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 09878 . This is a "SPECTERA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 115060 . This is a "EYEMED" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004149721 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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