1679506539 NPI number — SABRINA MICHELLE LACHOWICZ P.A.

Table of content: SABRINA MICHELLE LACHOWICZ P.A. (NPI 1679506539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679506539 NPI number — SABRINA MICHELLE LACHOWICZ P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LACHOWICZ
Provider First Name:
SABRINA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1679506539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 MAIN ST
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06795-2260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-993-8333
Provider Business Mailing Address Fax Number:
336-993-5144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 SEYMOUR ST STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106-5524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-459-4408
Provider Business Practice Location Address Fax Number:
860-545-9445
Provider Enumeration Date:
07/07/2006

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: 363A00000X , with the licence number:  3499 , 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: 001000150 . This is a "MEDICAL BOARD LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 003499 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1066715 . This is a "PA CERTIFICATE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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