Provider Demographics
NPI:1669252300
Name:ASIKAINEN, IVAN WILHELM
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:WILHELM
Last Name:ASIKAINEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:EASTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06242-9710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:270 MOHEGAN AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4150
Practice Address - Country:US
Practice Address - Phone:860-439-2086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer