1295805307 NPI number — M LOUISE RUINEN MSPT

Table of content: M LOUISE RUINEN MSPT (NPI 1295805307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295805307 NPI number — M LOUISE RUINEN MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUINEN
Provider First Name:
M
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPT
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:
1295805307
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:
51 SHERMAN HILL RD
Provider Second Line Business Mailing Address:
A-201
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06798-3648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-263-3104
Provider Business Mailing Address Fax Number:
203-263-4050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 SHERMAN HILL RD
Provider Second Line Business Practice Location Address:
A-201
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06798-3648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-263-3104
Provider Business Practice Location Address Fax Number:
203-263-4050
Provider Enumeration Date:
11/08/2006

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: 2251X0800X , with the licence number:  002186 , 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)

  • Identifier: 002186 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com