1114979226 NPI number — CARLSON THERAPY NETWORK, PC

Table of content: (NPI 1114979226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114979226 NPI number — CARLSON THERAPY NETWORK, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLSON THERAPY NETWORK, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1114979226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 DANBURY RD STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW MILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06776-3442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-799-6320
Provider Business Mailing Address Fax Number:
860-799-6621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 DANBURY RD STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW MILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06776-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-799-6320
Provider Business Practice Location Address Fax Number:
860-799-6621
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
BEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
860-799-6320

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: ========= . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CG7959 . This is a "MEDICARE RAILROAD GROUP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: OV5480 . This is a "HEALTHNET GROUP NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004210093 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83895 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: MPIN# 1764442 . This is a "UNITED HEALTH CARE OF NE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1543398 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: ANC589 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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