1679757900 NPI number — MRS. MARY JO HANNA FARRELLY RD, CDE

Table of content: MRS. MARY JO HANNA FARRELLY RD, CDE (NPI 1679757900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679757900 NPI number — MRS. MARY JO HANNA FARRELLY RD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRELLY
Provider First Name:
MARY JO
Provider Middle Name:
HANNA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CDE
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:
1679757900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
267 GRANT ST
Provider Second Line Business Mailing Address:
DIABETES EDUCATION CENTER
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06610-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-336-7305
Provider Business Mailing Address Fax Number:
203-384-4274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
267 GRANT ST
Provider Second Line Business Practice Location Address:
DIABETES EDUCATION CENTER
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06610-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-336-7305
Provider Business Practice Location Address Fax Number:
203-384-4274
Provider Enumeration Date:
12/21/2007

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com