1396075933 NPI number — THE INSTITUTE FOR NEURODEGENERATIVE DISORDERS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396075933 NPI number — THE INSTITUTE FOR NEURODEGENERATIVE DISORDERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE INSTITUTE FOR NEURODEGENERATIVE DISORDERS
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:
6
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:
1396075933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 TEMPLE ST
Provider Second Line Business Mailing Address:
SUITE 8B
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06510-2716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-401-4300
Provider Business Mailing Address Fax Number:
203-401-4304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 TEMPLE ST
Provider Second Line Business Practice Location Address:
SUITE 8B
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06510-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-401-4300
Provider Business Practice Location Address Fax Number:
203-401-4304
Provider Enumeration Date:
01/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MARIOTTI
Authorized Official First Name:
JACK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
203-401-4351

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084D0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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