1184788861 NPI number — MILFORD PODIATRY ASSOCIATES PC

Table of content: (NPI 1184788861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184788861 NPI number — MILFORD PODIATRY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILFORD PODIATRY ASSOCIATES 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:
6
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:
1184788861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 NEW HAVEN AVE
Provider Second Line Business Mailing Address:
UNIT A
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06460-6661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-878-9622
Provider Business Mailing Address Fax Number:
203-878-9622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 NEW HAVEN AVE
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06460-6661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-878-9622
Provider Business Practice Location Address Fax Number:
203-878-9622
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRESSMAN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
203-874-6755

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0161 , 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: IV5656 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 6840016 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2770673-001 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 5125138 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 764554 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 320 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004216900 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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