1255711883 NPI number — ROSE MARIE CAZZANI

Table of content: ROSE MARIE CAZZANI (NPI 1255711883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255711883 NPI number — ROSE MARIE CAZZANI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAZZANI
Provider First Name:
ROSE MARIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1255711883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 E BEL AIR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02920-4525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-338-0125
Provider Business Mailing Address Fax Number:
401-435-4231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 E BEL AIR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02920-4525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-392-0564
Provider Business Practice Location Address Fax Number:
401-435-4231
Provider Enumeration Date:
06/09/2015

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: 208100000X , with the licence number:  PTA00404 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: PT00404 , 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: 1255711883 . This is a "NPI" identifier . This identifiers is of the category "OTHER".