1477045359 NPI number — INFINITY OT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477045359 NPI number — INFINITY OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFINITY OT
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:
6
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:
1477045359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 COPPER HILL PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RINGWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07456-2820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-848-1677
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72 NEW LONDON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-848-1677
Provider Business Practice Location Address Fax Number:
603-746-2958
Provider Enumeration Date:
06/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
603-848-1677

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  1890 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3078299 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com