NPIMap

Organization Active NPI

Illume Fertility, PLLC

  • Reproductive Endocrinology Physician
  • Norwalk, CT
National Provider Identifier
1013086727
Registry record updated Mar 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Reproductive Endocrinology PhysicianTaxonomy code 207VE0102X
Legal business name
ILLUME FERTILITY, PLLC
Practice address
761 Main Ave
Suite 200
Norwalk, CT 06851-1080
Phone
(203) 750-7400
Fax
(203) 846-9579
NPI assigned
Nov 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robin Mangieri
Title
Ceo
Phone
(203) 912-3137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Reproductive Endocrinology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VE0102X Primary

Addresses

Primary practice location

761 Main Ave
Suite 200
Norwalk, CT 06851-1080

Mailing address

761 Main Ave
Suite 200
Norwalk, CT 06851-1080
Phone (203) 750-7400

Other identifiers 1

IdentifierTypeStateIssuer
753059794OtherCTTAX IDENTIFICATION NUMBER

Other names 1

  • REPRODUCTIVE MEDICINE ASSOCIATES OF CONNECTICUT, PC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Ambulatory Surgical Center at Reproductive Medicine3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

103 Newtown Rd
Ste A
Danbury, CT 06810

103 Newtown Rd
Ste 1A
Danbury, CT 06810

260 Long Ridge Rd
Fl 1
Stamford, CT 06902

260 Long Ridge Rd
#1
Stamford, CT 06902

115 Technology Dr
Unit C200
Trumbull, CT 06611

440 Mamaroneck Ave
Ste 501
Harrison, NY 10528

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1013086727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 MAIN AVE",
            "address_2": "SUITE 200",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068511080",
            "telephone_number": "203-750-7400",
            "fax_number": "203-846-9579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 MAIN AVE",
            "address_2": "SUITE 200",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068511080",
            "telephone_number": "203-750-7400",
            "fax_number": "203-846-9579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUME FERTILITY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A",
        "authorized_official_last_name": "MANGIERI",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "203-912-3137"
    },
    "taxonomies": [
        {
            "code": "207VE0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION NUMBER",
            "identifier": "753059794",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REPRODUCTIVE MEDICINE ASSOCIATES OF CONNECTICUT, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Norwalk, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.