1396135851 NPI number — JAMIZE BARLOW-PETTIFORD

Table of content: JAMIZE BARLOW-PETTIFORD (NPI 1396135851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396135851 NPI number — JAMIZE BARLOW-PETTIFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARLOW-PETTIFORD
Provider First Name:
JAMIZE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1396135851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 ROUTE 6
Provider Second Line Business Mailing Address:
PO BOX 200
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06237-1125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-228-4480
Provider Business Mailing Address Fax Number:
860-779-5437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
233 ROUTE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06237-1125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-228-4480
Provider Business Practice Location Address Fax Number:
860-779-5437
Provider Enumeration Date:
02/04/2015

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004040564 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com