NPI |
1528392636 |
The city name in the location address of the provider being identified. |
Entity Type Code |
1 |
The State code in the location of the provider
being identified. |
Provider Last Name Legal Name |
WACHS |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider First Name |
ROBIN |
The country code in the location address of the provider being identified. |
Provider Name Prefix Text |
DR. |
The telephone number associated with the location address of the provider being identified. |
Provider Credential Text |
PSY.D. |
The fax number associated with the location
address of the provider being identified. |
Provider First Line Business Practice Location Address |
1177 HIGH ROAD |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Second Line Business Practice Location Address |
SUITE 206 |
The date that a record was last updated or changed. |
Provider Business Practice Location Address City Name |
STAMFORD |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider Business Practice Location Address State Name |
CT |
The first name of the authorized official. |
Provider Business Practice Location Address Postal Code |
069051221 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
2032573875 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
9/22/2009 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
11/16/2015 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
103TC0700X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
002837 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
CT |
|
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
|