Basic Information
Provider Information
NPI: 1003003930
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BEHAN
FirstName: SEAN
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 401 CYPRESS ST
Address2:  
City: MANCHESTER
State: NH
PostalCode: 031033628
CountryCode: US
TelephoneNumber: 6036684111
FaxNumber: 6036287757
Practice Location
Address1: 1555 ELM ST
Address2:  
City: MANCHESTER
State: NH
PostalCode: 031011203
CountryCode: US
TelephoneNumber: 6036684111
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/25/2007
LastUpdateDate: 09/25/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X  Y Other Service ProvidersSpecialist 

No ID Information.


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