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HEALING EDGE MEDICAL ASSOCIATES LLC NPI 1134450828


NPI Information

NPI: 1134450828
Provider Name: HEALING EDGE MEDICAL ASSOCIATES LLC
Classification: Preventive Medicine - 2083P0500X
Entity Type: Organization

Specialization: Preventive Medicine/Occupational Environmental Medicine

Address:
29 KRIPES RD
SUITE M
EAST GRANBY, CT
ZIP 06026
Phone: (860) 413-3883
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HEALING EDGE MEDICAL ASSOCIATES LLC is a preventive medicine/occupational environmental medicine preventive medicine in East Granby, CT. The provider is a preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. HEALING EDGE MEDICAL ASSOCIATES LLC NPI is 1134450828. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

29 KRIPES RD
SUITE M
EAST GRANBY, CT
ZIP 06026-669
Phone: (860) 413-3883
Fax: (860) 413-3884

The provider's authorized official is Ronald Dale Agnes .
The authorized official title is President/physician and has the following contact phone number (860) 978-8825.

The enumeration date for this NPI number is 1/20/2010 and was last updated on 6/19/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207P00000XEmergency Medicine036511CONNECTICUTNo
22083P0500XPreventive MedicinePreventive Medicine/Occupational Environmental Medicine036511CONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1F23694MEDICARE UPINILLINOIS
2J13195OTHERILLINOISMEDICARE
33097037MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.