1043379936 NPI number — MRS. JILL DEE PELUNIS MS CCC SLP

Table of content: MRS. JILL DEE PELUNIS MS CCC SLP (NPI 1043379936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043379936 NPI number — MRS. JILL DEE PELUNIS MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELUNIS
Provider First Name:
JILL
Provider Middle Name:
DEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HABALOW
Provider Other First Name:
JILL
Provider Other Middle Name:
DEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP CCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043379936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 SIMON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-883-8205
Provider Business Mailing Address Fax Number:
603-881-7198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 COMMERCE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATKINSON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-893-1299
Provider Business Practice Location Address Fax Number:
603-893-5401
Provider Enumeration Date:
12/06/2006

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: 235Z00000X , with the licence number:  0032 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 272746 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 561822 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 626514 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 761242 . This is a "TUFTS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".