1245892207 NPI number — ROHITH MOHAN NAIR

Table of content: ROHITH MOHAN NAIR (NPI 1245892207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245892207 NPI number — ROHITH MOHAN NAIR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAIR
Provider First Name:
ROHITH
Provider Middle Name:
MOHAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NAIR
Provider Other First Name:
ROHITH
Provider Other Middle Name:
MOHAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1245892207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
472 MAPLE ST APT A11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12601-3682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-452-6719
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 HOSPITAL HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06069-2096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-364-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  72218 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 72218 , 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)