1396722575 NPI number — ALI VAEZY MD

Table of content: ALI VAEZY MD (NPI 1396722575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396722575 NPI number — ALI VAEZY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAEZY
Provider First Name:
ALI
Provider Middle Name:
Provider Name Prefix Text:
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:
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:
1396722575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 YORK ST
Provider Second Line Business Mailing Address:
YNHH WEST PAVILION, 2ND FL
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06510-3220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-785-4081
Provider Business Mailing Address Fax Number:
203-737-2228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 YORK ST
Provider Second Line Business Practice Location Address:
YNHH WEST PAVILION, 2ND FL
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06510-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-785-4081
Provider Business Practice Location Address Fax Number:
203-737-2228
Provider Enumeration Date:
12/28/2005

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: 208000000X , with the licence number:  040741 , 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: 001407411 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220133 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3408207/7603504 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 23-33843 . This is a "UHC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "RR MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 23-33843 . This is a "AMERICHOICE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 912708 . This is a "USA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010040741CT02 . This is a "ANTHEM BCBS CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 040741 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V1459 . This is a "HEALTHNET/COMMERCIAL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2978576 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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