1861613200 NPI number — HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD

Table of content: (NPI 1861613200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861613200 NPI number — HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD
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:
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD
Provider Other Organization Name Type Code:
3
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:
1861613200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73 BEECHWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAWTUCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02860-5409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-724-4040
Provider Business Mailing Address Fax Number:
401-722-9575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73 BEECHWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-724-4040
Provider Business Practice Location Address Fax Number:
401-722-9575
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ETTENSOHN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
401-724-4040

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  6164 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 9817 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 6245 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 6164 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 9817 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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