1154725125 NPI number — NORWALK OPERATIONS LLC

Table of content: (NPI 1154725125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154725125 NPI number — NORWALK OPERATIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORWALK OPERATIONS LLC
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:
AUTUMN LAKE HEALTHCARE AT NORWALK
Provider Other Organization Name Type Code:
3
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:
1154725125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4260 ROUTE 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07731-3351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-358-6883
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 MIDROCKS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06851-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-847-9686
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STERN
Authorized Official First Name:
ARYEH
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
732-358-6883

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2401 , 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)