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NPI Code Detail

MEDICARE: MR. EDWARD BARRY KRAVITZ MS, ATC, LAT

MEDICARE: MR. EDWARD BARRY KRAVITZ MS, ATC, LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer000118CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PROVIDER CODE 22OTHERCTRESPIRATORY, REHABILITATI

General Provider Information

NPI Number : 1942423710
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDWARD BARRY KRAVITZ MS, ATC, LAT
Provider Business Mailing Address
First Line : 466 S ELM ST
Second Line :
City : WALLINGFORD
State : CT
Zip : 06492-4817
Country : US
Telephone Number : 860-805-7259
Fax Number :
Provider Business Practice Location Address
First Line : 230 GEORGE ST
Second Line :
City : NEW HAVEN
State : CT
Zip : 06510-3224
Country : US
Telephone Number : 203-498-5980
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 07/08/2007

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