1710098645 NPI number — ALLERGY AND ASTHMA CARE OF FAIRFIELD COUNTY, LLC

Table of content: (NPI 1710098645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710098645 NPI number — ALLERGY AND ASTHMA CARE OF FAIRFIELD COUNTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY AND ASTHMA CARE OF FAIRFIELD COUNTY, LLC
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:
1710098645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 WALLS DR
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06824-5163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-259-7070
Provider Business Mailing Address Fax Number:
203-254-7402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 WALLS DR
Provider Second Line Business Practice Location Address:
STE 405
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06824-5163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-259-7070
Provider Business Practice Location Address Fax Number:
203-254-7402
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BACKMAN
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-259-7070

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  038854 , 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: 038854 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1439465 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P861731 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010038854CT02 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7914842006 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0V8243 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com