Healthcare Provider Details

I. General information

NPI: 1255344321
Provider Name (Legal Business Name): A.E. HERTZLER KNOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PROHEALTH PHYSICIANS OF BRISTOL 1251 FARMINGTON AVE.
BRISTOL CT
06010
US

IV. Provider business mailing address

PROHEALTH PHYSICIANS OF BRISTOL 1251 FARMINGTON AVE.
BRISTOL CT
06010
US

V. Phone/Fax

Practice location:
  • Phone: 860-584-4535
  • Fax: 860-589-7656
Mailing address:
  • Phone: 860-584-4535
  • Fax: 860-589-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number029692
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: