1639505043 NPI number — CYNTHIA L SARRIS, PA, LLC

Table of content: (NPI 1639505043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639505043 NPI number — CYNTHIA L SARRIS, PA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYNTHIA L SARRIS, PA, LLC
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:
1639505043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 GRANITE HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILLINGWORTH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06419-2211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-395-9110
Provider Business Mailing Address Fax Number:
860-663-2629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 GRANITE HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILLINGWORTH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06419-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-395-9110
Provider Business Practice Location Address Fax Number:
860-663-2629
Provider Enumeration Date:
09/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VOGT
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
860-395-9110

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  006192 , 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: MCD008007950 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com