1275359366 NPI number — RAVSHANDZHON NAZHMIDDINOV APRN

Table of content: RAVSHANDZHON NAZHMIDDINOV APRN (NPI 1275359366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275359366 NPI number — RAVSHANDZHON NAZHMIDDINOV APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAZHMIDDINOV
Provider First Name:
RAVSHANDZHON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
M

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:
1275359366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 CURRIER WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESHIRE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06410-1432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-544-3521
Provider Business Mailing Address Fax Number:
203-544-3521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CELLINI PL STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06516-1666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-488-7228
Provider Business Practice Location Address Fax Number:
203-204-1415
Provider Enumeration Date:
11/23/2024

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: 363LF0000X , with the licence number:  14258 , 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)





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