1710954961 NPI number — CONNECTICUT OBGYN

Table of content: (NPI 1710954961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710954961 NPI number — CONNECTICUT OBGYN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT OBGYN
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:
1710954961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
580 BURNSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-761-1234
Provider Business Mailing Address Fax Number:
860-528-2341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 BURNSIDE AVE
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
EAST HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-761-1234
Provider Business Practice Location Address Fax Number:
860-528-2341
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIMAYE
Authorized Official First Name:
PARESH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
860-761-1234

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  036874 , 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: 0368745121 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2619324 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010036874CT02 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0371247003 . This is a "SIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0V9709 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1278544 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00136874601 . This is a "MEDICAID HMO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 189162 . This is a "MEDICAID HMO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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