1083611297 NPI number — KAREN J CUSANO A.P.R.N.

Table of content: KAREN J CUSANO A.P.R.N. (NPI 1083611297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083611297 NPI number — KAREN J CUSANO A.P.R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUSANO
Provider First Name:
KAREN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.P.R.N.
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:
1083611297
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:
269 CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMSTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06231-1403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-228-9463
Provider Business Mailing Address Fax Number:
860-228-3766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMSTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06231-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-228-9463
Provider Business Practice Location Address Fax Number:
860-228-3766
Provider Enumeration Date:
07/01/2005

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: 207R00000X , with the licence number:  001634 , 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: 2V1323 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 163400 . This is a "CT CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400001634CT02 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2985559 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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