1669662110 NPI number — DR. ROBERT T CROVO D.P.M.

Table of content: DR. ROBERT T CROVO D.P.M. (NPI 1669662110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669662110 NPI number — DR. ROBERT T CROVO D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROVO
Provider First Name:
ROBERT
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669662110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 NEW LITCHFIELD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06790-6414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-489-1661
Provider Business Mailing Address Fax Number:
860-489-5147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 NEW LITCHFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06790-6414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-489-1661
Provider Business Practice Location Address Fax Number:
860-489-5147
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  000032 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OVO493 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 480069612 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0207740001 . This is a "DME SUPPLIER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 032000 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 030000032CT02 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004006490 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2740028 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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