1619037124 NPI number — JACQUELINE J LITTZI

Table of content: JACQUELINE J LITTZI (NPI 1619037124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619037124 NPI number — JACQUELINE J LITTZI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LITTZI
Provider First Name:
JACQUELINE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1619037124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 CROSS RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CANAAN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06840-2312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-966-4200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CANAAN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06840-5507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-966-4200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2006

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: 207W00000X , with the licence number:  032333 , 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: 032333 . This is a "STATE LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010032333CT02 . This is a "ANTHEM IS ID NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061343834 . This is a "STATE TAX ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 125633 . This is a "AETNA INS PROVIDER NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: ZS750 . This is a "OXFORD INS ID NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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