1063412831 NPI number — MRS. ELAINE HRISTON-ZECH RPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063412831 NPI number — MRS. ELAINE HRISTON-ZECH RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HRISTON-ZECH
Provider First Name:
ELAINE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1063412831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 GROVE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CANAAN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06840-5330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-966-5752
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CANAAN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06840-5330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-966-5752
Provider Business Practice Location Address Fax Number:
203-966-7507
Provider Enumeration Date:
07/22/2005

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: 225100000X , with the licence number:  CT02654 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: NY2561352 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: ANC1555 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080002635CT01 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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