1366486219 NPI number — ROSEANNE GOLDBERG R.P.T.

Table of content: ROSEANNE GOLDBERG R.P.T. (NPI 1366486219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366486219 NPI number — ROSEANNE GOLDBERG R.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDBERG
Provider First Name:
ROSEANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.P.T.
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:
1366486219
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:
130 DIVISION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERBY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06418-1326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-732-1580
Provider Business Mailing Address Fax Number:
203-732-1576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERBY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06418-1326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-732-1580
Provider Business Practice Location Address Fax Number:
203-732-1576
Provider Enumeration Date:
06/15/2006

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: 225100000X , with the licence number:  001632 , 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: 00424281400 . This is a "BLUECARE FAMILY PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 659984 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080001632CT01 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V3989 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7710575 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: A752119 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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