1871902502 NPI number — MR. BRIAN MICHAEL ULLMAN APRN, RN

Table of content: MR. BRIAN MICHAEL ULLMAN APRN, RN (NPI 1871902502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871902502 NPI number — MR. BRIAN MICHAEL ULLMAN APRN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ULLMAN
Provider First Name:
BRIAN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
APRN, RN
Provider Gender Code:
M

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:
1871902502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERBY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06418-1328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-732-1330
Provider Business Mailing Address Fax Number:
203-732-1332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAUGATUCK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06770-2929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-729-0755
Provider Business Practice Location Address Fax Number:
203-729-0797
Provider Enumeration Date:
08/06/2014

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: 363LP0808X , with the licence number:  5837 , 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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