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1710470034 NPI number — GINA M CONFREDO

NPI Number: 1710470034
Health Care Provider/Practitioner: GINA M CONFREDO

Information about “1710470034” NPI (GINA M CONFREDO) exists in 1710470034 in HTML format HTML  |  1710470034 in plain Text format TXT  |  1710470034 in PDF (Portable Document Format) PDF  |  1710470034 in an XML format XML  formats.

NPI Number : 1710470034 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710470034",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CONFREDO",
    "FirstName": "GINA",
    "MiddleName": "M",
    "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": "1290 SILAS DEANE HWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WETHERSFIELD",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06109-4337",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-335-0454",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "275 MOUNT CARMEL AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HAMDEN",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06518-1961",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-407-4050",
    "PracticeLocationAddressFaxNumber": "203-616-4131",
    "EnumerationDate": "06/12/2018",
    "LastUpdateDate": "01/12/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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