1639309040 NPI number — MRS. KIMBERLY SIMONS MURPHY OTR/L

Table of content: MRS. KIMBERLY SIMONS MURPHY OTR/L (NPI 1639309040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639309040 NPI number — MRS. KIMBERLY SIMONS MURPHY OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURPHY
Provider First Name:
KIMBERLY
Provider Middle Name:
SIMONS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
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:
1639309040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2660 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 309
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06606-5369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-337-4494
Provider Business Mailing Address Fax Number:
203-337-4910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2660 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06606-5369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-337-4494
Provider Business Practice Location Address Fax Number:
203-337-4910
Provider Enumeration Date:
07/20/2009

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: 225XH1200X , with the licence number:  002575 , 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: 001299107 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2V8333 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: ZS224 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010029910CT01 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4351331 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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