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 | 261QM2800X | Clinic/Center | Methadone | SA-0190 | 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 | 008071202 | OTHER | CONNECTICUT | MEDICAID AMYNAH DHARANI |
| 2 | 008064860 | OTHER | CONNECTICUT | WEISS MEDICAID |
| 3 | 008048733 | OTHER | CONNECTICUT | SUCHMAN MEDICAID |
| 4 | 008003745 | OTHER | CONNECTICUT | ASCESS/MEDCAID/MMT |
| 5 | 008001077 | OTHER | CONNECTICUT | MOORE MEDICAID |
| 6 | 008038040 | OTHER | CONNECTICUT | LENCZYCKI MEDICAID |
| 7 | D400357267 | MEDICARE PIN | CONNECTICUT | |
| 8 | D400357474 | MEDICARE PIN | CONNECTICUT | |
| 9 | D400318461 | MEDICARE PIN | CONNECTICUT | |
| 10 | D40076510 | MEDICARE PIN | CONNECTICUT | |
| 11 | D400365390 | MEDICARE PIN | CONNECTICUT | |
| 12 | D400363247 | MEDICARE PIN | CONNECTICUT | |
| 13 | D400358574 | MEDICARE PIN | CONNECTICUT | |
| 14 | D400346532 | MEDICARE PIN | CONNECTICUT | |
| 15 | 008069118 | OTHER | CONNECTICUT | CAMPBELL MEDICAID # |
| 16 | 008063396 | OTHER | CONNECTICUT | MEMISEVICH MEDICAID |
| 17 | 008058728 | OTHER | CONNECTICUT | RIERA TIMOTHY MEDICAID |
| 18 | 008040283 | OTHER | CONNECTICUT | CAMENGA MEDICAID |
| 19 | 008038036 | OTHER | CONNECTICUT | BAKER MEDICAID |
| 20 | 440000058 | MEDICARE PIN | CONNECTICUT | |
| 21 | D400172220 | MEDICARE PIN | CONNECTICUT | |
| 22 | 008063217 | OTHER | CONNECTICUT | APPLEGET MEDICAID |
| 23 | 001307439 | OTHER | CONNECTICUT | ALTICE MEDICAID |
| 24 | 001423136 | OTHER | CONNECTICUT | TETRAULT MEDICAID |
| 25 | 008038044 | OTHER | CONNECTICUT | FARNUM MEDICAID |
| 26 | G06184 | MEDICARE UPIN | CONNECTICUT | |
| 27 | D400082725 | MEDICARE PIN | CONNECTICUT | |
| 28 | 110004627 | MEDICARE PIN | CONNECTICUT | |
| 29 | D400083844 | MEDICARE PIN | CONNECTICUT | |
| 30 | 008058058 | OTHER | CONNECTICUT | SADINSKY MEDICAID |
| 31 | 008042701 | OTHER | CONNECTICUT | KATZMAN MEDICAID |
| 32 | 008039605 | OTHER | CONNECTICUT | HERMES MEDICAID # |
| 33 | 008038741 | OTHER | CONNECTICUT | OWEN MEDICAID |
| 34 | 008066801 | OTHER | CONNECTICUT | HAQUE MEDICAID |
| 35 | 001340132 | OTHER | CONNECTICUT | SAVAGE MEDICAID |
| 36 | 008048372 | OTHER | CONNECTICUT | SHARMAIN MEDICAID |
| 37 | 001155787 | OTHER | CONNECTICUT | SHIMELMAN MEDICAID |
| 38 | 008057135 | OTHER | CONNECTICUT | MEDICAID HEATHER KNOX |
| 39 | 008053091 | OTHER | CONNECTICUT | BUTNER MEDICAID |
| 40 | 008009745 | OTHER | COLORADO | DESROSIERS MEDCAID |
| 41 | D400132157 | MEDICARE PIN | CONNECTICUT | |
| 42 | 001302497 | OTHER | CONNECTICUT | SHI MEDICAID |
| 43 | 008048393 | OTHER | CONNECTICUT | BARRY MEDICAID |
| 44 | D400372444 | MEDICARE PIN | CONNECTICUT | |
| 45 | 001218107 | OTHER | CONNECTICUT | SCHOTTENFELD MEDICAID |
| 46 | 008057039 | OTHER | CONNECTICUT | MILLER MEDICAID |
| 47 | 008037391 | OTHER | CONNECTICUT | SHACKELL MEDICAID |
| 48 | 008038042 | OTHER | CONNECTICUT | POLANETSKA MEDICAID |
| 49 | 008038043 | OTHER | CONNECTICUT | WHELAN MEDICAID |
| 50 | D400081097 | MEDICARE PIN | CONNECTICUT | |
