1811191554 NPI number — MS. CONSTANCE ANN CASTELLI GREENE RN MS CDE RD CDN CMH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811191554 NPI number — MS. CONSTANCE ANN CASTELLI GREENE RN MS CDE RD CDN CMH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENE
Provider First Name:
CONSTANCE
Provider Middle Name:
ANN CASTELLI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN MS CDE RD CDN CMH
Provider Gender Code:
F

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:
1811191554
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:
284 QUARRY ROAD
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-414-7612
Provider Business Mailing Address Fax Number:
203-877-5918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
284 QUARRY ROAD
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-414-7612
Provider Business Practice Location Address Fax Number:
203-877-5918
Provider Enumeration Date:
06/14/2007

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: 133N00000X , with the licence number:  00245 CD N , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 133V00000X , with the licence number: 000245 RD , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163W00000X , with the licence number: E31188 RN MS , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: OV6321 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2593836 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 270000245CT01 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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