1609093731 NPI number — JENNIFER PAGNAMENTA RPT

Table of content: JENNIFER PAGNAMENTA RPT (NPI 1609093731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609093731 NPI number — JENNIFER PAGNAMENTA RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGNAMENTA
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1609093731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 COWLES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06798-1726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-263-3104
Provider Business Mailing Address Fax Number:
203-263-4050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 SHERMAN HILL RD STE A201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06798-3694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-263-3104
Provider Business Practice Location Address Fax Number:
203-263-4050
Provider Enumeration Date:
04/19/2007

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: 2251X0800X , with the licence number:  006100 , 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: 006100 . This is a "PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com