1720336415 NPI number — HAMMERS HEALTHCARE IMAGING, LLC

Table of content: (NPI 1720336415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720336415 NPI number — HAMMERS HEALTHCARE IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMMERS HEALTHCARE IMAGING, 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:
1720336415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 CHURCH STREET SOUTH
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-773-8959
Provider Business Mailing Address Fax Number:
203-773-8962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CHURCH ST S
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06519-1717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-773-8959
Provider Business Practice Location Address Fax Number:
203-773-8962
Provider Enumeration Date:
08/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMERS
Authorized Official First Name:
LYNWOOD
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
RADIOLOGIST
Authorized Official Telephone Number:
203-773-8959

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  000183 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X , with the licence number: 000183 , 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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