1225206329 NPI number — LOUJIL INC

Table of content: (NPI 1225206329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225206329 NPI number — LOUJIL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUJIL INC
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:
1225206329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
465 LONSDALE AVE
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
PAWTUCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02860-1874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-475-5655
Provider Business Mailing Address Fax Number:
401-475-2631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 LONSDALE AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-1874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-475-5655
Provider Business Practice Location Address Fax Number:
401-475-2631
Provider Enumeration Date:
02/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KISHFY
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/PIC
Authorized Official Telephone Number:
401-475-5655

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHA00438 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4107048 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: LI 69635 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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