1487630232 NPI number — MRS. CHRISTINE J CALABRESE APRN

Table of content: LISA CHRISTINE OBERMEIT PHD (NPI 1922533124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487630232 NPI number — MRS. CHRISTINE J CALABRESE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALABRESE
Provider First Name:
CHRISTINE
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
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:
MARTIN
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487630232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 KENSINGTON AVE
Provider Second Line Business Mailing Address:
GROVE HILL MEDICAL CENTER
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06051-3916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-224-6249
Provider Business Mailing Address Fax Number:
860-224-6241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 KENSINGTON AVE
Provider Second Line Business Practice Location Address:
GROVE HILL MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEW BRITAIN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06051-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-224-6249
Provider Business Practice Location Address Fax Number:
860-224-6241
Provider Enumeration Date:
12/22/2005

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: 363LA2200X , with the licence number:  002568 , 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: 004224846 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: P3174405 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V7696 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 400002568CT04 . This is a "BCBS ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1255448155 . This is a "GHMC GROUP NPI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 400002568CT04 . This is a "BCFP MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004221959 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0256801190 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 370368 . This is a "WELLCARE MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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