1053679431 NPI number — ALESSANDRA CAPOBIANCO M.D.

Table of content: ALESSANDRA CAPOBIANCO M.D. (NPI 1053679431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053679431 NPI number — ALESSANDRA CAPOBIANCO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAPOBIANCO
Provider First Name:
ALESSANDRA
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:
1053679431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 CHAPEL ST
Provider Second Line Business Mailing Address:
NEMG - YNH GERIATRIC SERVICES
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06511-4405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-688-8200
Provider Business Mailing Address Fax Number:
203-688-8204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 CHAPEL ST
Provider Second Line Business Practice Location Address:
NEMG - YNH GERIATRIC SERVICES
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06511-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-688-8200
Provider Business Practice Location Address Fax Number:
203-688-8204
Provider Enumeration Date:
04/24/2012

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: 207R00000X , with the licence number:  55077 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: 55077 , 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: 1053679431 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0982346 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1053679431 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1474140 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4950610 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3082578 . This is a "COVENTRY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1053679431 . This is a "MULTIPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1053679431 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1053679431 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: AA562455 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P5755157 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com