Healthcare Provider Details

I. General information

NPI: 1992717250
Provider Name (Legal Business Name): TORY Z WESTBROOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E MAIN ST
CLINTON CT
06413-2112
US

IV. Provider business mailing address

PO BOX 2477
SHELTON CT
06484-5804
US

V. Phone/Fax

Practice location:
  • Phone: 860-664-0787
  • Fax: 860-664-1982
Mailing address:
  • Phone: 860-347-6971
  • Fax: 860-664-1982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number039082
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: