1275657223 NPI number — DR. NINRONG XUE GIEBISCH M.D.,PH.D.

Table of content: DR. NINRONG XUE GIEBISCH M.D.,PH.D. (NPI 1275657223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275657223 NPI number — DR. NINRONG XUE GIEBISCH M.D.,PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIEBISCH
Provider First Name:
NINRONG
Provider Middle Name:
XUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
XUE
Provider Other First Name:
NINRONG
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.,PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275657223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 FOREST GLEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06525-1422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-387-5581
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 WATSON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRATFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06615-7127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-381-4917
Provider Business Practice Location Address Fax Number:
203-381-4004
Provider Enumeration Date:
03/16/2007

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: 174400000X , with the licence number:  036383 , 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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