Masonicare

Primary specialty

Rehabilitation HospitalTaxonomy code 283X00000X

License

003288 Issued in CT

Legal business name

MASONICARE

Practice address

22 Masonic Ave
Rehab Department
Wallingford, CT 06492-3048

Phone

(203) 679-5900

Fax

(203) 679-6142

NPI assigned

Aug 12, 2010

Organization subpart

No

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

Authorized official

Name

Susan Fagan, OTR/L

Title

Rehab Director

Phone

(203) 679-6247

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281571200000",
    "number": "1104131283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 MASONIC AVE",
            "address_2": "REHAB DEPARTMENT",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064923048",
            "telephone_number": "203-679-5900",
            "fax_number": "203-679-6142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 MASONIC AVE",
            "address_2": "REHAB DEPARTMENT",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064923048",
            "telephone_number": "203-679-5900",
            "fax_number": "203-679-6142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASONICARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-12",
        "last_updated": "2010-08-12",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "REHAB DIRECTOR",
        "authorized_official_telephone_number": "203-679-6247",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "CT",
            "license": "003288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura M Martineau, OTR
• Annemieke Ausloos Martino, PT, DPT
• Casey Martins, AUD
• Stacey L. Martwinski-Nardozzi, MSW
• Masonic Healthcare Center
• Masonicare
• Masonicare
• Masonicare Behavioral Health, LLC
• Masonicare Health Center
• Masonicare Health Center

• Rehabilitation Hospital in Wallingford, CT
• Providers in Wallingford, CT by specialty
• Rehabilitation Hospital in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2010; 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.