Healthcare Provider Details

I. General information

NPI: 1194652982
Provider Name (Legal Business Name): ANTHONY EMMANUEL LEMBERT IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CRYSTAL LAKE RD
GROTON CT
06349-2300
US

IV. Provider business mailing address

176 LAKE DR E
OAKDALE CT
06370
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-3011
  • Fax:
Mailing address:
  • Phone: 860-581-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: