1699912139 NPI number — ELLIOT PHYSICIAN NETWORK

Table of content: (NPI 1699912139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699912139 NPI number — ELLIOT PHYSICIAN NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELLIOT PHYSICIAN NETWORK
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:
6
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:
1699912139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 CYPRESS ST
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03103-3600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-669-9450
Provider Business Mailing Address Fax Number:
603-669-1858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 CYPRESS ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03103-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-669-9450
Provider Business Practice Location Address Fax Number:
603-669-1858
Provider Enumeration Date:
01/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HERMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DIRECTOR OF OPERATION AND FINANCE
Authorized Official Telephone Number:
603-663-4904

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RE5600 . This is a "MEDICARE GROUP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com