Provider Demographics
NPI:1609056936
Name:11:11 PRODUCTIONS, INC.
Entity type:Organization
Organization Name:11:11 PRODUCTIONS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, LAC
Authorized Official - Phone:203-264-6624
Mailing Address - Street 1:220 MAIN ST S
Mailing Address - Street 2:C/O HOLISTIC HEALTH CENTER
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2275
Mailing Address - Country:US
Mailing Address - Phone:203-264-6624
Mailing Address - Fax:203-267-6642
Practice Address - Street 1:220 MAIN ST S
Practice Address - Street 2:C/O HOLISTIC HEALTH CENTER
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2275
Practice Address - Country:US
Practice Address - Phone:203-264-6624
Practice Address - Fax:203-267-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-03
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000036171100000X
CT003704208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02569Medicare PIN