1205370137 NPI number — THE LIGHT TIME GIFT HEALTH CARE LLC

Table of content: DR. JOSEPH LOUIS TONORE JR. MD (NPI 1871563882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205370137 NPI number — THE LIGHT TIME GIFT HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LIGHT TIME GIFT HEALTH CARE 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:
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:
1205370137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 EDGEWATER PL
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
WAKEFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01880-1293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-876-1065
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 EDGEWATER PL
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
WAKEFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01880-1293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-876-1065
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
TOBI
Authorized Official First Name:
UNUAGBON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-876-1065

Provider Taxonomy Codes

  • Taxonomy code: 253J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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