1932285202 NPI number — DR. JOHN JOSEPH PIOLI PHD

Table of content: DR. JOHN JOSEPH PIOLI PHD (NPI 1932285202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932285202 NPI number — DR. JOHN JOSEPH PIOLI PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIOLI
Provider First Name:
JOHN
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1932285202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1495 BLACK ROCK TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06825-4165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-366-3570
Provider Business Mailing Address Fax Number:
203-459-1967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1495 BLACK ROCK TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06825-4165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-366-3570
Provider Business Practice Location Address Fax Number:
203-459-1967
Provider Enumeration Date:
10/31/2006

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: 103T00000X , with the licence number:  CT1206 , 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: 060001206CT01 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0007759 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 176787 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121682 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4062334 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4320150 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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