1376524058 NPI number — JOSEPH VINCENT PORTEREIKO DO

Table of content: JOSEPH VINCENT PORTEREIKO DO (NPI 1376524058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376524058 NPI number — JOSEPH VINCENT PORTEREIKO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTEREIKO
Provider First Name:
JOSEPH
Provider Middle Name:
VINCENT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1376524058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HARTFORD HOSPITAL PROFESSIONAL SERVICES
Provider Second Line Business Mailing Address:
PO BOX 40000 DEPT 634
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06151-0634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-545-7602
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 SEYMOUR ST
Provider Second Line Business Practice Location Address:
HARTFORD HOSPITAL TRAUMA DEPT
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-545-3112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2005

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: 2086S0102X , with the licence number:  040485 , 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)