1538125455 NPI number — MRS. MARIA J BRENNAN APRN

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 1538125455 NPI number — MRS. MARIA J BRENNAN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENNAN
Provider First Name:
MARIA
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:
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:
1538125455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 CANTERBURY RD.
Provider Second Line Business Mailing Address:
WINDHAM UROLOGY GROUP
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-412-0491
Provider Business Mailing Address Fax Number:
860-412-0496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 CANTERBURY RD
Provider Second Line Business Practice Location Address:
WINDHAM UROLOGY GROUP
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-412-0491
Provider Business Practice Location Address Fax Number:
860-412-0496
Provider Enumeration Date:
04/21/2006

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: 363LA2200X , with the licence number:  001754 , 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: 00419867900 . This is a "BLUECARE FAMILY PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 500000089 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004198679 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2V4032 . This is a "HEALTHNET OF CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2971942 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 40000175CT01 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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