CHESHIRE FITNESS ZONE, LLC

Provider Demographics

• NPI: 1205961547
• Name: CHESHIRE FITNESS ZONE, LLC
• Entity type: Organization
• Organization Name: CHESHIRE FITNESS ZONE, LLC
• Authorized Official - Title/Position: OWNER
• Authorized Official - Prefix: MR
• Authorized Official - First Name: CRAIG
• Authorized Official - Middle Name: M
• Authorized Official - Last Name: GOLDSTEIN
• Authorized Official - Credentials: PT
• Authorized Official - Phone: 203-250-9663
• Mailing Address - Street 1: 382 S MAIN ST
• Mailing Address - City: CHESHIRE
• Mailing Address - State: CT
• Mailing Address - Zip Code: 06410-1379
• Mailing Address - Country: US
• Mailing Address - Phone: 203-250-9663
• Mailing Address - Fax: 203-699-9641
• Practice Address - Street 1: 382 S MAIN ST
• Practice Address - City: CHESHIRE
• Practice Address - State: CT
• Practice Address - Zip Code: 06410-1379
• Practice Address - Country: US
• Practice Address - Phone: 203-250-9663
• Practice Address - Fax: 203-699-9641
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-02-23
• Last Update Date: 2020-06-29

Provider Licenses

State	License ID	Taxonomies
CT	005678	174400000X, 2251P0200X
CT	002758	225XP0200X
CT	003550	235Z00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2251P0200X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist	Pediatrics	Group - Multi-Specialty
No	174400000X	Other Service Providers	Specialist		Group - Multi-Specialty
No	225XP0200X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist	Pediatrics	Group - Multi-Specialty
No	235Z00000X	Speech, Language and Hearing Service Providers	Speech-Language Pathologist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CT	0100901	Other	AETNA ORTHONET
CT	100901	Other	HEALTHNET ORTHONET - ID
CT	1257980	Other	CIGNA
CT	3672389002	Other	CIGNA
CT	64-04292	Other	UNITED HEALTHCARE ID
CT	754954	Other	CONNECTICARE
CT	9168247	Other	AETNA
CT	0800005678CT01	Other	BCBS-CRAIG GOLDSTEIN, PT
CT	080005678CT01	Other	BCBS - PROVIDER ID
CT	2370736	Other	AETNA
CT	754954	Other	CONNECTICARE - ID
CT	004209674	Medicaid
CT	2V8125	Other	HEALTHNET - ID
CT	3672389002	Other	CIGNA - PROVIDER ID
CT	50CHESFITCT01	Other	BCBS-CHESHIRE FITNESS ZONE, FACILITY
CT	61594157	Other	MEDSPAN
CT	0100901	Other	BCBS ORTHONET
CT	660003550CT01	Other	BCBS
CT	9044356	Other	AETNA
CT	12701	Other	CIGNA - ORTHONET ID
CT	64-04292	Other	UNITED HEALTHCARE
CT	12701	Other	CIGNA ORTHONET
CT	130002758CT01	Other	BCBS
CT	2370736	Other	AETNA - PROVIDER ID
CT	A2646342	Other	OXFORD HEALTHCARE ID