1154614543 NPI number — CENTER FOR THE HEALING ARTS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154614543 NPI number — CENTER FOR THE HEALING ARTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR THE HEALING ARTS, 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:
1154614543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 110172
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUMBULL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06611-0172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-799-7733
Provider Business Mailing Address Fax Number:
203-987-4853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 KINGS HIGHWAY EAST, SUITE 108
Provider Second Line Business Practice Location Address:
C/O WHOLE BODY MEDICINE
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-799-7733
Provider Business Practice Location Address Fax Number:
203-987-4853
Provider Enumeration Date:
05/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SICA
Authorized Official First Name:
ROBBAN
Authorized Official Middle Name:
ARIEL
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
203-799-7733

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  026453 , 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)





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