1235281288 NPI number — BLOOMFIELD FOOT SPECIALISTS,LLC

Table of content: (NPI 1235281288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235281288 NPI number — BLOOMFIELD FOOT SPECIALISTS,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOMFIELD FOOT SPECIALISTS,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:
1235281288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 BLOOMFIELD AVE STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06002-2480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-243-2951
Provider Business Mailing Address Fax Number:
860-243-5790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 BLOOMFIELD AVE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06002-2480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-243-2951
Provider Business Practice Location Address Fax Number:
860-243-5790
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEBLANC
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PODIATIRST
Authorized Official Telephone Number:
860-243-1951

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 000530 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1162763 . This is a "UNITED HEALTH PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V4184 . This is a "HEALTH NET PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004235653 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0170716 . This is a "CIGNA PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1093710972 . This is a "NPI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 030000530CT04 . This is a "ANTHEM PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1235281288 . This is a "NPI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3204678 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PL0161 . This is a "MEDIBLUE PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 748411 . This is a "CONNECTICARE PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: HAS386 . This is a "OXFORD PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 298258 . This is a "WELLCARE PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 480000912 . This is a "MEDICARE PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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