NPIMap

Organization Active NPI

Physician Services of Northeast

  • Nurse Practitioner
  • Putnam, CT
National Provider Identifier
1669603767
Registry record updated Dec 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
PHYSICIAN SERVICES OF NORTHEAST
Doing business as
PHYSICIAN SERVICES OF NORTHEAST CT, LLC
Practice address
320 Pomfret St
Suite, CSB2
Putnam, CT 06260-1836
Phone
(860) 928-6541
Fax
(860) 963-6091
NPI assigned
Aug 6, 2009
Organization subpart
Yes
Parent organization
DAY KIMBALL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 9, 2010

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

Authorized official

Name
Julie M Drouin
Title
Cfo
Phone
(860) 928-6541

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X

Addresses

Primary practice location

320 Pomfret St
Suite, CSB2
Putnam, CT 06260-1836

Mailing address

320 Pomfret St
Suite CSB#2
Putnam, CT 06260-1836
Phone (860) 928-6541

Other names 1

  • PHYSICIAN SERVICES OF NORTHEAST CT, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Physician Services of Northeast6 organizations share this tax ID, including this one
Part of
Day Kimball Healthcare Inc

Other organizations with this tax ID 5

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1669603767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 POMFRET ST",
            "address_2": "SUITE CSB#2",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062601836",
            "telephone_number": "860-928-6541",
            "fax_number": "860-963-6091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 POMFRET ST",
            "address_2": "SUITE, CSB2",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062601836",
            "telephone_number": "860-928-6541",
            "fax_number": "860-963-6091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SERVICES OF NORTHEAST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAY KIMBALL HOSPITAL",
        "enumeration_date": "2009-08-06",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "DROUIN",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "860-928-6541"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICIAN SERVICES OF NORTHEAST CT, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Putnam, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.