1891982005 NPI number — STAMFORD ARTHRITIS CARE, LLC

Table of content: (NPI 1891982005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891982005 NPI number — STAMFORD ARTHRITIS CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAMFORD ARTHRITIS CARE, LLC
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:
1891982005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1266 E MAIN ST
Provider Second Line Business Mailing Address:
SUITE 700R
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06902-3546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-487-0280
Provider Business Mailing Address Fax Number:
203-487-0279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1266 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 700R
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06902-3546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-487-0280
Provider Business Practice Location Address Fax Number:
203-487-0279
Provider Enumeration Date:
10/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAN
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-487-0280

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  037521 , 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)

  • Identifier: 1891982005 . This is a "ORGANIZATION NPI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C03453 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010037521CT01 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V7063 . This is a "HEALTH NET PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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