1710946298 NPI number — JOHN C BINKOWSKI JR.

Table of content: MR. DALE EUGENE HAWKINS EFDA (NPI 1174038541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710946298 NPI number — JOHN C BINKOWSKI JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BINKOWSKI
Provider First Name:
JOHN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
Provider Gender Code:
M

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:
1710946298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 ARMSTRONG RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06484-4721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-929-7353
Provider Business Mailing Address Fax Number:
203-929-0756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 MAIN ST
Provider Second Line Business Practice Location Address:
ST VINCENTS MEDICAL CENTER
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06606-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-929-7353
Provider Business Practice Location Address Fax Number:
203-929-0756
Provider Enumeration Date:
03/22/2006

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: 367500000X , with the licence number:  E41805 , 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)