1073585386 NPI number — JOHN D BIANCHINI P.T.

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 1073585386 NPI number — JOHN D BIANCHINI P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIANCHINI
Provider First Name:
JOHN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

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:
1073585386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROSPECT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06712-0205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-758-5040
Provider Business Mailing Address Fax Number:
203-758-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 WATERBURY RD
Provider Second Line Business Practice Location Address:
STE. 1C
Provider Business Practice Location Address City Name:
PROSPECT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06712-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-758-5040
Provider Business Practice Location Address Fax Number:
203-758-5042
Provider Enumeration Date:
02/02/2006

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: 2251X0800X , with the licence number:  5831 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 007742 , 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: 080007742CT01 . This is a "ANTHEM BC BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080007742CT02 . This is a "ANTHEM BC BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080007742CT06 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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