1356371744 NPI number — DR. DEBMALYA MUKHERJEE MD

Table of content: KENNETH WAYNE NORDLUND N.P (NPI 1356385082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356371744 NPI number — DR. DEBMALYA MUKHERJEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUKHERJEE
Provider First Name:
DEBMALYA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUKHERJEE
Provider Other First Name:
DEB
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., M.B.A.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1356371744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2842 MAIN ST STE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASTONBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06033-1077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 STATE ST FL 26
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02109-1827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-347-4108
Provider Business Practice Location Address Fax Number:
616-830-8213
Provider Enumeration Date:
07/03/2006

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: 207R00000X , with the licence number:  044815 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 233803 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 233803 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 044815 , 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: 001448150 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1356371744 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 134550 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 510492088 . This is a "UHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA113569 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9585080 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: CT0000439 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010044815CTD1 . This is a "BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 510492088 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J42785 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2148480 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44815 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".




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