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 Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 261Q00000X | Clinic/Center | | 0737 | CONNECTICUT | Yes |
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 Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 008066948 | OTHER | CONNECTICUT | LOUIE MEDICAID |
| 2 | D400344291 | MEDICARE PIN | CONNECTICUT | |
| 3 | 008058058 | OTHER | CONNECTICUT | SADINSKY MEDICAID |
| 4 | D400318461 | MEDICARE PIN | CONNECTICUT | |
| 5 | D400081097 | MEDICARE PIN | CONNECTICUT | |
| 6 | D400346532 | MEDICARE PIN | CONNECTICUT | |
| 7 | 001218107 | OTHER | CONNECTICUT | SCHOTTENFELD MEDICAID |
| 8 | 008066293 | OTHER | CONNECTICUT | MARDAM BEY MEDICAID |
| 9 | 008066801 | OTHER | CONNECTICUT | HAQUE MEDICAID |
| 10 | 008068420 | OTHER | CONNECTICUT | SCHEFILITI MEDICAID |
| 11 | 110004627 | MEDICARE PIN | CONNECTICUT | |
| 12 | D400172220 | MEDICARE PIN | CONNECTICUT | |
| 13 | 001302497 | OTHER | CONNECTICUT | MEDICAID SHI |
| 14 | D400315836 | MEDICARE PIN | CONNECTICUT | |
| 15 | 008053091 | OTHER | CONNECTICUT | MEDICAID BUTNER # |
| 16 | 008069118 | OTHER | CONNECTICUT | CAMPBELL MEDICAID # |
| 17 | 008003745 | OTHER | CONNECTICUT | MEDICAID EMILY APRN |
| 18 | D400083844 | MEDICARE PIN | CONNECTICUT | |
| 19 | 001423136 | OTHER | CONNECTICUT | MEDICAID TETRAULT |
| 20 | D400278702 | MEDICARE PIN | CONNECTICUT | |
| 21 | 008066315 | OTHER | CONNECTICUT | COLON RIVERA MEDICAID |
| 22 | D400316058 | MEDICARE PIN | CONNECTICUT | |
| 23 | D400278647 | MEDICARE PIN | CONNECTICUT | |
| 24 | D400318431 | MEDICARE PIN | CONNECTICUT | |
| 25 | D400318773 | MEDICARE PIN | CONNECTICUT | |
