1528435047 NPI number — CHANTEL GINEO

Table of content: JANET LEE RUCHIM NURSE (NPI 1396897054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528435047 NPI number — CHANTEL GINEO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANTEL GINEO
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:
1528435047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 HIGHLAND TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06053-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 ALBANY TPKE
Provider Second Line Business Practice Location Address:
SUITE 3010
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06019-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-637-6559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GINEO
Authorized Official First Name:
CHANTEL
Authorized Official Middle Name:
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
860-637-6559

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  002799 , 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)





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