1124021928 NPI number — TOWN OF BERLIN OFFICE OF THE TREASU RER

Table of content: (NPI 1124021928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124021928 NPI number — TOWN OF BERLIN OFFICE OF THE TREASU RER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF BERLIN OFFICE OF THE TREASU RER
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:
1124021928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 KENSINGTON RD
Provider Second Line Business Mailing Address:
STE 12
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06037-2655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-828-7030
Provider Business Mailing Address Fax Number:
860-828-7420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 KENSINGTON RD
Provider Second Line Business Practice Location Address:
STE 12
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06037-2655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-828-7030
Provider Business Practice Location Address Fax Number:
860-828-7420
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COLELLA
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
860-828-7030

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  C-804010 , 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: 702016-01 . This is a "MD HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 782127 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: A785612 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 702016 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 60-00077 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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