1942218144 NPI number — BRISTOL PATHOLOGY CONSULTANTS, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942218144 NPI number — BRISTOL PATHOLOGY CONSULTANTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRISTOL PATHOLOGY CONSULTANTS, P.C.
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:
1942218144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 EAST RIVER DRIVE
Provider Second Line Business Mailing Address:
5TH FLOOR
Provider Business Mailing Address City Name:
EAST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06108-7301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-282-4128
Provider Business Mailing Address Fax Number:
860-289-0746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 BREWSTER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-282-4128
Provider Business Practice Location Address Fax Number:
860-289-0746
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BANERJEE
Authorized Official First Name:
NASIMA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, BPC
Authorized Official Telephone Number:
860-282-4128

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004209872 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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