1639790504 NPI number — THREE 62 TEN RESEARCH GROUP, INC

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 1639790504 NPI number — THREE 62 TEN RESEARCH GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THREE 62 TEN RESEARCH GROUP, INC
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:
1639790504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
570 BARNUM AVE STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06608-2446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
570 BARNUM AVE STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06608-2446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-603-4688
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KAUSHIK
Authorized Official First Name:
SAGAR
Authorized Official Middle Name:
NIKHIL
Authorized Official Title or Position:
VP RESEARCH AND DEVELOPMENT
Authorized Official Telephone Number:
917-603-4688

Provider Taxonomy Codes

  • Taxonomy code: 261QR1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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