1285608687 NPI number — DR. ANTHONY REGONINI O.D.

Table of content: DR. ANTHONY REGONINI O.D. (NPI 1285608687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285608687 NPI number — DR. ANTHONY REGONINI O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REGONINI
Provider First Name:
ANTHONY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
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:
1285608687
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:
1176 MEMORIAL DR
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
CHICOPEE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01020-3958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-593-3101
Provider Business Mailing Address Fax Number:
413-593-3114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1176 MEMORIAL DR
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
CHICOPEE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01020-3958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-593-3101
Provider Business Practice Location Address Fax Number:
413-593-3114
Provider Enumeration Date:
02/14/2006

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: 152W00000X , with the licence number:  2686 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 561543 . This is a "US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7293579 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0335487 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15835 . This is a "HEALTH NEW ENGLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 561543 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W15398 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000029813 . This is a "BOSTON MEDICAL CENTER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 760862 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 796816 . This is a "CT CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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