1457677270 NPI number — CLINICAL PATHOLOGY CONSULTANTS OF SOUTHERN CONNECTICUT, LLC

Table of content: (NPI 1457677270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457677270 NPI number — CLINICAL PATHOLOGY CONSULTANTS OF SOUTHERN CONNECTICUT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL PATHOLOGY CONSULTANTS OF SOUTHERN CONNECTICUT, LLC
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:
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:
1457677270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1909
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-852-2649
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-852-2649
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NAIR
Authorized Official First Name:
SARASWATHI
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIR
Authorized Official Telephone Number:
860-852-2652

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , 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: 4064515 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: A687787 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061113482 . This is a "MULTIPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 500HBL073CT01 . This is a "BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 713482 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0063241 . This is a "US HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0582874 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C00502 . This is a "MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 022040 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0063241 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061113482 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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