1457388183 NPI number — LAUREEN FORGIONE-RUBINO MD

Table of content: LAUREEN FORGIONE-RUBINO MD (NPI 1457388183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457388183 NPI number — LAUREEN FORGIONE-RUBINO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORGIONE-RUBINO
Provider First Name:
LAUREEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1457388183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
945 MAIN STREET
Provider Second Line Business Mailing Address:
SUITE #105
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-645-1232
Provider Business Mailing Address Fax Number:
860-647-0438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
945 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE #105
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-645-1232
Provider Business Practice Location Address Fax Number:
860-647-0438
Provider Enumeration Date:
06/27/2006

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: 208600000X , with the licence number:  033061 , 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: 010033061CT01 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004249810 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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