1306916846 NPI number — DR. ANTONIO PANTALEO M.D.

Table of content: DR. ANTONIO PANTALEO M.D. (NPI 1306916846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306916846 NPI number — DR. ANTONIO PANTALEO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANTALEO
Provider First Name:
ANTONIO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1306916846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
945 SUMMER ST FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06905-5557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-359-2444
Provider Business Mailing Address Fax Number:
203-359-3169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
945 SUMMER ST FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-359-2444
Provider Business Practice Location Address Fax Number:
203-359-3169
Provider Enumeration Date:
11/09/2006

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: 207RE0101X , with the licence number:  CT42295 , 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: 201102818 . This is a "TAX ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V3586 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010042295CT01 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001422956 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7725568 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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