HEALING EDGE MEDICAL ASSOCIATES LLC (NPI# 1134450828) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134450828 |
| Entity Type | Organization |
| Organization Name | HEALING EDGE MEDICAL ASSOCIATES LLC |
| Practice Address |
29 Kripes Rd Suite M East Granby CT 06026-9669 |
| Mailing Address |
Po Box 152 Simsbury CT 06070-0152 |
| Practice Telephone | 8604133883 |
| Practice Fax Number | 8604133884 |
| Mailing Telephone | 8609788825 |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2013-06-19 |
| Authorized Official Name | DR. RONALD DALE AGNES JR. (PRESIDENT/PHYSICIAN) |
| Authorized Official Telephone | 8609788825 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 036511 | CT | Allopathic & Osteopathic Physicians |
| Y | 2083P0500X |
Preventive Medicine Specialization: Preventive Medicine/Occupational Environmental Medicine |
036511 | CT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE | J13195 | 01 |
| IL | 3097037 | 05 |
| Street Address |
29 KRIPES RD SUITE M |
| City | EAST GRANBY |
| State | CT |
| Zip Code | 06026-9669 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518225051 | Susan Moffatt Agnes | Dietitian, Registered | 29 Kripes Rd, East Granby, CT 06026-9669 | 2012-05-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174811160 | Rosa Noda-clark | Dental Hygienist | 1 Chelsea Ln, East Granby, CT 06026 | 2011-07-12 |
| 1346366945 | Petra Irmgard Mursch | Chiropractor | 56a Rainbow Road, East Granby, CT 06026 | 2007-03-22 |
| 1851456743 | Ellen Farmer Lanctot | Chiropractor | 19 South Main St, East Granby, CT 06026 | 2006-12-22 |
| 1891855573 | Kathleen J Armata | Counselor | 59-61 Rainbow Road, East Granby, CT 06026 | 2006-12-11 |
| 1417312943 | Coleen Sutherland | Behavioral Analyst | 15 School Street, East Granby, CT 06026 | 2015-12-29 |
| 1295038446 | Christine Noelle Levine | Behavioral Analyst | 15 School Street, East Granby, CT 06026 | 2010-12-09 |
| 1275630402 | Robert L Gordon | Dentist | 11 S Main St, East Granby, CT 06026 | 2006-09-20 |
| 1760469829 | David R Howlett | Family Medicine | 13 Church Rd, East Granby, CT 06026-0518 | 2005-12-29 |
| 1528045697 | Jeannie M Crabtree | Nurse Practitioner | 13 Church St, East Granby, CT 06026-0518 | 2005-12-29 |
| 1326105958 | Anne M Reiher | Family Medicine | 13 Church Rd, East Granby, CT 06026-0518 | 2007-01-02 |
| Find all providers in zip 06026 | ||||
| Taxonomy Code | 2083P0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Preventive Medicine/Occupational Environmental Medicine |
| A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689126336 | Geoffrey Etherington | Preventive Medicine | 302 Rte 81, Killingworth, CT 06419 | 2016-10-28 |
| 1184930455 | Khaula Khatlani | Preventive Medicine | 975 Farmington Ave Ste 1, Bristol, CT 06010-3964 | 2010-08-25 |
| 1306074570 | James P Mooney Jr. | Preventive Medicine | 352 Timberlane Dr, Orange, CT 06477-2845 | 2009-06-26 |
| 1407004955 | Leo Albert Millette | Preventive Medicine | 185 Old Branchville Rd, Ridgefield, CT 06877-6013 | 2008-09-08 |
| 1902821267 | Alexander Blair Smith | Preventive Medicine | 1075 Tolland Tpke, Manchester, CT 06042-1609 | 2006-07-13 |
| 1710957261 | Paul C Kelleher | Preventive Medicine | 169 High Meadow Ln, Mystic, CT 06355-1651 | 2006-01-26 |
| 1427028216 | Kathryn Lee Johnson | Preventive Medicine | 20 Goodwin St, Niantic, CT 06357-3610 | 2006-01-24 |
| 1235736315 | Healthstat Health Center Aces | Preventive Medicine | 261 Skiff St, Hamden, CT 06517-1016 | 2020-10-02 |
| 1457732703 | Louis Fazen | Preventive Medicine | 135 College St Fl 3, New Haven, CT 06510-2483 | 2015-06-12 |
| 1053747691 | Jonathan Borak | Preventive Medicine | 234 Church St, New Haven, CT 06510-1804 | 2013-09-15 |
| Find all providers with the same taxonomy | ||||
| City | EAST GRANBY |
| Zip Code | 06026 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.