Basic Information
| Provider Information | |||||||||
| NPI: | 1487889655 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | APT FOUNDATION INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | ACCESS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1 LONG WHARF DR | ||||||||
| Address2: | SUITE 321 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065115991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037814600 | ||||||||
| FaxNumber: | 2037814624 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 LONG WHARF DR | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065115991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037814357 | ||||||||
| FaxNumber: | 2037814705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2009 | ||||||||
| LastUpdateDate: | 04/26/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MADDEN | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 2037814600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | SA-0190 | CT | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
ID Information
| ID | Type | State | Issuer | Description | 001302497 | 01 | CT | SHI MEDICAID | OTHER | 008003745 | 01 | CT | ASCESS/MEDCAID/MMT | OTHER | 008038040 | 01 | CT | LENCZYCKI MEDICAID | OTHER | 008063396 | 01 | CT | MEMISEVICH MEDICAID | OTHER | 001340132 | 01 | CT | SAVAGE MEDICAID | OTHER | 008057039 | 01 | CT | MILLER MEDICAID | OTHER | 008057135 | 01 | CT | MEDICAID HEATHER KNOX | OTHER | 008058728 | 01 | CT | RIERA TIMOTHY MEDICAID | OTHER | 001155787 | 01 | CT | SHIMELMAN MEDICAID | OTHER | 008037391 | 01 | CT | SHACKELL MEDICAID | OTHER | 008038036 | 01 | CT | BAKER MEDICAID | OTHER | 008048372 | 01 | CT | SHARMAIN MEDICAID | OTHER | 001307439 | 01 | CT | ALTICE MEDICAID | OTHER | 001423136 | 01 | CT | TETRAULT MEDICAID | OTHER | 008001077 | 01 | CT | MOORE MEDICAID | OTHER | 008038042 | 01 | CT | POLANETSKA MEDICAID | OTHER | 001218107 | 01 | CT | SCHOTTENFELD MEDICAID | OTHER | 008053091 | 01 | CT | BUTNER MEDICAID | OTHER | 008058058 | 01 | CT | SADINSKY MEDICAID | OTHER | 008009745 | 01 | CO | DESROSIERS MEDCAID | OTHER | 008038044 | 01 | CT | FARNUM MEDICAID | OTHER | 008039605 | 01 | CT | HERMES MEDICAID # | OTHER | 008042701 | 01 | CT | KATZMAN MEDICAID | OTHER | 008048393 | 01 | CT | BARRY MEDICAID | OTHER | 008048733 | 01 | CT | SUCHMAN MEDICAID | OTHER | 008063217 | 01 | CT | APPLEGET MEDICAID | OTHER | 008066801 | 01 | CT | HAQUE MEDICAID | OTHER | 008069118 | 01 | CT | CAMPBELL MEDICAID # | OTHER | 008038043 | 01 | CT | WHELAN MEDICAID | OTHER | 008038741 | 01 | CT | OWEN MEDICAID | OTHER | 008040283 | 01 | CT | CAMENGA MEDICAID | OTHER | 008064860 | 01 | CT | WEISS MEDICAID | OTHER | 008071202 | 01 | CT | MEDICAID AMYNAH DHARANI | OTHER |