Healthcare Provider Details

I. General information

NPI: 1538415286
Provider Name (Legal Business Name): BRUCE KISTOPHER ROFF LMT, DIPL. AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OLD ROUTE 7
BROOKFIELD CT
06804-1711
US

IV. Provider business mailing address

31 OLD ROUTE 7
BROOKFIELD CT
06804-1711
US

V. Phone/Fax

Practice location:
  • Phone: 203-740-9300
  • Fax:
Mailing address:
  • Phone: 203-740-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004050
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000591
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number019223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: