1861717183 NPI number — PAUL ERNEST DUFRESNE MS, R.PH., DPH

Table of content: PAUL ERNEST DUFRESNE MS, R.PH., DPH (NPI 1861717183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861717183 NPI number — PAUL ERNEST DUFRESNE MS, R.PH., DPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUFRESNE
Provider First Name:
PAUL
Provider Middle Name:
ERNEST
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, R.PH., DPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUFRESNE
Provider Other First Name:
PAUL
Provider Other Middle Name:
ERNEST
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1861717183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 MOODY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06082-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-763-7020
Provider Business Mailing Address Fax Number:
860-763-7022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 MOODY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06082-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-763-7020
Provider Business Practice Location Address Fax Number:
860-763-7022
Provider Enumeration Date:
03/30/2010

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: 1835P0018X , with the licence number:  7200 , 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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