1134197759 NPI number — STEVEN BUCHBINDER DPM

Table of content: STEVEN BUCHBINDER DPM (NPI 1134197759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134197759 NPI number — STEVEN BUCHBINDER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCHBINDER
Provider First Name:
STEVEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1134197759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 W MAIN ST STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06001-4306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-674-1200
Provider Business Mailing Address Fax Number:
860-674-1206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
STE 107
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-674-1200
Provider Business Practice Location Address Fax Number:
860-674-1206
Provider Enumeration Date:
03/09/2006

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: 213E00000X , with the licence number:  000020 , 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: 030000020CT03 . This is a "BSBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4004560 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0G4389 . This is a "CT CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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