Provider Demographics
NPI:1174633143
Name:PLANNED PARENTHOOD OF SOUTHERN NEW ENGLAND, INC.
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF SOUTHERN NEW ENGLAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:TABAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-752-8816
Mailing Address - Street 1:345 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2348
Mailing Address - Country:US
Mailing Address - Phone:203-752-2856
Mailing Address - Fax:
Practice Address - Street 1:345 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2348
Practice Address - Country:US
Practice Address - Phone:203-752-2856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02907Medicare PIN