1689740300 NPI number — GROVE HILL MEDICAL CENTER PC

Table of content: GEORGE HUMBERTO BORDENAVE MD (NPI 1326035767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689740300 NPI number — GROVE HILL MEDICAL CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROVE HILL MEDICAL CENTER PC
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:
1689740300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 KENSINGTON AVE
Provider Second Line Business Mailing Address:
GROVE HILL MEDICAL
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06051-3916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-801-6759
Provider Business Mailing Address Fax Number:
860-348-4873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 BERLIN RD SUITE 102
Provider Second Line Business Practice Location Address:
GROVE HILL MEDICAL CENTER
Provider Business Practice Location Address City Name:
CROMWELL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-635-2810
Provider Business Practice Location Address Fax Number:
860-623-2352
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GENOVESI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
860-224-6266

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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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