1669468534 NPI number — RACHEL ADELIA LIM LEONARDI D.O.

Table of content: RACHEL ADELIA LIM LEONARDI D.O. (NPI 1669468534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669468534 NPI number — RACHEL ADELIA LIM LEONARDI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEONARDI
Provider First Name:
RACHEL
Provider Middle Name:
ADELIA LIM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIM
Provider Other First Name:
RACHEL
Provider Other Middle Name:
ADELIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669468534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 CORPORATE DR
Provider Second Line Business Mailing Address:
SUITE 484
Provider Business Mailing Address City Name:
SHELTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06484-6211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-944-9898
Provider Business Mailing Address Fax Number:
203-944-9899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 CORPORATE DR
Provider Second Line Business Practice Location Address:
SUITE 484
Provider Business Practice Location Address City Name:
SHELTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06484-6211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-944-9898
Provider Business Practice Location Address Fax Number:
203-944-9899
Provider Enumeration Date:
09/26/2005

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: 207V00000X , with the licence number:  045470 , 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)





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