Healthcare Provider Details

I. General information

NPI: 1902130008
Provider Name (Legal Business Name): ROBERTO LAUREANO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WADSWORTH ST
HARTFORD CT
06106-7108
US

IV. Provider business mailing address

PO BOX 2951
NEW BRITAIN CT
06050-2951
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-1124
  • Fax: 860-724-2539
Mailing address:
  • Phone: 860-777-6195
  • Fax: 860-225-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: