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1477412070 NPI number — OPTIMUM MEDICAL SERVICES

NPI Number: 1477412070
Health Care Provider/Practitioner: OPTIMUM MEDICAL SERVICES

Information about “1477412070” NPI (OPTIMUM MEDICAL SERVICES) exists in 1477412070 in HTML format HTML  |  1477412070 in plain Text format TXT  |  1477412070 in PDF (Portable Document Format) PDF  |  1477412070 in an XML format XML  formats.

NPI Number : 1477412070 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477412070",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "OPTIMUM MEDICAL SERVICES",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "119 OLD ANSONIA RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SEYMOUR",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06483-3512",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-913-4061",
    "MailingAddressFaxNumber": "203-734-2363",
    "FirstLinePracticeLocationAddress": "3 ARMSTRONG RD # 1053",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SHELTON",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06484-4706",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-913-4061",
    "PracticeLocationAddressFaxNumber": "203-734-2363",
    "EnumerationDate": "01/19/2026",
    "LastUpdateDate": "01/19/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GILLES",
    "AuthorizedOfficialFirstName": "SAMENTHAG",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "APRN",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "FNP",
    "AuthorizedOfficialTelephoneNumber": "203-343-8077",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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