1265720163 NPI number — NEWINGTON BEHAVIORAL HEALTH

Table of content: (NPI 1265720163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265720163 NPI number — NEWINGTON BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWINGTON BEHAVIORAL HEALTH
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:
1265720163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
93 ROCKLEDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06111-5152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-887-5950
Provider Business Mailing Address Fax Number:
866-514-0409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1268 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
NEWINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06111-3038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-667-3965
Provider Business Practice Location Address Fax Number:
866-514-0409
Provider Enumeration Date:
07/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ARIMORO
Authorized Official First Name:
GABRIEL
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PSYCHIATRIST
Authorized Official Telephone Number:
203-887-5950

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AVRS 00800431 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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