1770617409 NPI number — ELLINGTON OBSTETRICS & GYNECOLOGY ASSOCIATES, P.C.

Table of content: (NPI 1770617409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770617409 NPI number — ELLINGTON OBSTETRICS & GYNECOLOGY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELLINGTON OBSTETRICS & GYNECOLOGY ASSOCIATES, P.C.
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:
1770617409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 419
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06029-0419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-872-7854
Provider Business Mailing Address Fax Number:
860-870-7944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 WEST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06029-3777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-872-7854
Provider Business Practice Location Address Fax Number:
860-870-7944
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
LENORA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
860-872-7854

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LX0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com