1649611096 NPI number — PLAYFUL DEVELOPMENT, LLC

Table of content: (NPI 1649611096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649611096 NPI number — PLAYFUL DEVELOPMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLAYFUL DEVELOPMENT, 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:
1649611096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
547 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH GLASTONBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06073-3120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-657-3454
Provider Business Mailing Address Fax Number:
860-657-8680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
547 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GLASTONBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06073-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-657-3454
Provider Business Practice Location Address Fax Number:
860-657-8680
Provider Enumeration Date:
07/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
STEFANO
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PEDIATRIC OCCUPATIONAL THERAP
Authorized Official Telephone Number:
860-657-3454

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  002485 , 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: 0491420 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 130002485CT02 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0040350 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0491420 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 102485 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 771008 . This is a "OPTUM UNITED HEALTHCARE SOLUTIONS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008011895 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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