1336195015 NPI number — HARTFORD ANESTHESIOLOGY ASSOCIATES, INC.

Table of content: (NPI 1336195015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336195015 NPI number — HARTFORD ANESTHESIOLOGY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARTFORD ANESTHESIOLOGY ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336195015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 E RIVER DR FL 5
Provider Second Line Business Mailing Address:
C/O IPMS
Provider Business Mailing Address City Name:
EAST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06108-7301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-282-4022
Provider Business Mailing Address Fax Number:
860-282-0834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 SEYMOUR ST
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06108-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-545-2117
Provider Business Practice Location Address Fax Number:
860-289-0834
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GASZEK
Authorized Official First Name:
EWA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALER
Authorized Official Telephone Number:
860-282-4022

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004208709 . This is a "MEDICAID APRN GROUP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004000162 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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