NPIMap

Organization Active NPI

Dr. Decio M. de Escobar

  • Otolaryngic Allergy Physician
  • Waterbury, CT
National Provider Identifier
1386931277
Registry record updated Jun 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngic Allergy PhysicianTaxonomy code 207YX0602X
License
12669 Issued in CT
Legal business name
DR. DECIO M. DE ESCOBAR
Practice address
171 Grandview Ave
Suite 101
Waterbury, CT 06708-2517
Phone
(203) 757-9336
Fax
(203) 757-9611
NPI assigned
Jun 30, 2011
Last updated
Jun 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2011

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

Authorized official

Name
Danelle Contois, CPC
Title
Medical Biller
Phone
(203) 757-9336

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
NaturopathGroup: 193200000X MULTI-SPECIALTY GROUP 175F00000X 000352 CT
Otolaryngic Allergy PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YX0602X 12669 CT Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X 1139 CT

Addresses

Primary practice location

171 Grandview Ave
Suite 101
Waterbury, CT 06708-2517

Mailing address

171 Grandview Ave
Suite 101
Waterbury, CT 06708-2517
Phone (203) 757-9336

Other identifiers 1

IdentifierTypeStateIssuer
001126697MedicaidCT

Other names 1

  • Corebella Health Other name

National Provider Directory

National Provider Directory

Locations

171 Grandview Ave
Ste 101
Waterbury, CT 06708
Phone (203) 757-9336

NPI Registry JSON

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309392000000",
    "number": "1386931277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 GRANDVIEW AVE",
            "address_2": "SUITE 101",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082517",
            "telephone_number": "203-757-9336",
            "fax_number": "203-757-9611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 GRANDVIEW AVE",
            "address_2": "SUITE 101",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082517",
            "telephone_number": "203-757-9336",
            "fax_number": "203-757-9611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. DECIO M. DE ESCOBAR",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-30",
        "last_updated": "2011-06-30",
        "status": "A",
        "authorized_official_last_name": "CONTOIS",
        "authorized_official_first_name": "DANELLE",
        "authorized_official_title_or_position": "MEDICAL BILLER",
        "authorized_official_telephone_number": "203-757-9336",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "175F00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Naturopath",
            "state": "CT",
            "license": "000352",
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "CT",
            "license": "12669",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "1139",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001126697",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corebella Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2011; 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.