1417913740 NPI number — JANE BUCKLEY APRN

Table of content: JANE BUCKLEY APRN (NPI 1417913740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417913740 NPI number — JANE BUCKLEY APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCKLEY
Provider First Name:
JANE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1417913740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06473-2365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-745-6202
Provider Business Mailing Address Fax Number:
203-234-0801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06473-2365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-234-0365
Provider Business Practice Location Address Fax Number:
203-234-0801
Provider Enumeration Date:
04/25/2006

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: 363LP0808X , with the licence number:  002431 , 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: P2528334 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1932350105 . This is a "GROUP INDENIFIER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 298056 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 454047 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400002431CT02 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2208919 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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