1487728754 NPI number — DEBORAH ASHTON MOLLOY MS,APRN

Table of content: DEBORAH ASHTON MOLLOY MS,APRN (NPI 1487728754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487728754 NPI number — DEBORAH ASHTON MOLLOY MS,APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLLOY
Provider First Name:
DEBORAH
Provider Middle Name:
ASHTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS,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:
1487728754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1781 HIGHLAND AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CHESHIRE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06410-1254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-272-1990
Provider Business Mailing Address Fax Number:
203-271-0668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1781 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CHESHIRE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06410-1254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-272-1990
Provider Business Practice Location Address Fax Number:
203-271-0668
Provider Enumeration Date:
11/20/2006

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: 363LW0102X , with the licence number:  000024 , 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: 000024 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V2619 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 400000024CT01 . This is a "BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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