NPIMap

Organization Active NPI

Illume Fertility, PLLC

  • Ambulatory Fertility Facility
  • Norwalk, CT
National Provider Identifier
1013179902
Registry record updated Apr 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Fertility FacilityTaxonomy code 261QA0006X
Legal business name
ILLUME FERTILITY, PLLC
Practice address
761 Main Ave
Suite 200
Norwalk, CT 06851-1080
Phone
(203) 750-7400
NPI assigned
Jul 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 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) 750-7400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Fertility Facility 261QA0006X Primary
Ambulatory Surgical Clinic/Center 261QA1903X 0320 CT

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 names 1

  • Ambulatory Surgical Center at Reproductive Medicine Other 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.

NPI Registry JSON

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

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649030400000",
    "number": "1013179902",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUME FERTILITY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-01",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A",
        "authorized_official_last_name": "MANGIERI",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "203-750-7400"
    },
    "taxonomies": [
        {
            "code": "261QA0006X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Fertility Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CT",
            "license": "0320",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ambulatory Surgical Center at Reproductive Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Ambulatory Surgical Center at Reproductive Medicine",
            "code": "5",
            "type": "Other 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 Apr 4, 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.