1043261266 NPI number — MARTHA PIMENTEL M.D.

Table of content: MARTHA PIMENTEL M.D. (NPI 1043261266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043261266 NPI number — MARTHA PIMENTEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIMENTEL
Provider First Name:
MARTHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1043261266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
172 MOUNT PLEASANT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06470-1443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-628-2015
Provider Business Mailing Address Fax Number:
845-628-2483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 MOUNT PLEASANT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06470-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-628-2015
Provider Business Practice Location Address Fax Number:
845-628-2483
Provider Enumeration Date:
05/12/2006

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: 208000000X , with the licence number:  034706 , 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: 001347063 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2V8451 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P434110 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1262509 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7994115 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1367473 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 810774517 . This is a "PHCS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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