1083757900 NPI number — GLENN SHINNER AU.D.

Table of content: GLENN SHINNER AU.D. (NPI 1083757900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083757900 NPI number — GLENN SHINNER AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHINNER
Provider First Name:
GLENN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
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:
1083757900
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:
241 KING ST STE 119
Provider Second Line Business Mailing Address:
HAMPSHIRE HEARING SERVICES
Provider Business Mailing Address City Name:
NORTHAMPTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01060-2341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-586-9572
Provider Business Mailing Address Fax Number:
413-582-7923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 KING ST STE 119
Provider Second Line Business Practice Location Address:
HAMPSHIRE HEARING SERVICES
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01060-2341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-586-9572
Provider Business Practice Location Address Fax Number:
413-582-7923
Provider Enumeration Date:
02/14/2007

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: 231H00000X , with the licence number:  193 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 19923 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 793123 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 19918 . This is a "HARVARD PILGRIM HEALTH PL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 701242 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AD 0010 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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