Provider Demographics
NPI:1497460802
Name:ARLINE, GINNISE
Entity Type:Individual
Prefix:
First Name:GINNISE
Middle Name:
Last Name:ARLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 NEW PARK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1142
Mailing Address - Country:US
Mailing Address - Phone:860-985-8608
Mailing Address - Fax:
Practice Address - Street 1:48 CAPITOL AVE
Practice Address - Street 2:#2R
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-9402
Practice Address - Country:US
Practice Address - Phone:860-985-8608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT174400000X
CT1196158335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No174400000XOther Service ProvidersSpecialist