1346286523 NPI number — MR. TIMOTHY W FERRAROTTI PA

Table of content: MR. TIMOTHY W FERRAROTTI PA (NPI 1346286523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346286523 NPI number — MR. TIMOTHY W FERRAROTTI PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRAROTTI
Provider First Name:
TIMOTHY
Provider Middle Name:
W
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1346286523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 LITCHFIELD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06790-6679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-496-6650
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 LITCHFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06790-6679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-496-6650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2006

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: 363AM0700X , with the licence number:  000608 , 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: 628737 . This is a "CONNECTICARE GROUP #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 000608 . This is a "LICENSE #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CK7848 . This is a "RAILROAD GROUP #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0608003630 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500HBE262CT01 . This is a "BCBS GROUP #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 789159 . This is a "MVP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 970030307 . This is a "RAILROAD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060800 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C02911 . This is a "MEDICARE PIN GROUP #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 99318 . This is a "GHI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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