1922378496 NPI number — OPTIMUS HEALTH CARE INC

Table of content: (NPI 1922378496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922378496 NPI number — OPTIMUS HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIMUS HEALTH CARE INC
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:
6
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:
1922378496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
982 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06608-1913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-696-3260
Provider Business Mailing Address Fax Number:
203-332-0376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
727 HONEYSPOT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRATFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06615-7172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-375-7252
Provider Business Practice Location Address Fax Number:
203-332-0376
Provider Enumeration Date:
12/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SPINELLI
Authorized Official First Name:
LUDWIG
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
203-696-3260

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  0234 , 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: 004234788 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: C00383 . This is a "MEDICARE PART B" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com