Healthcare Provider Details

I. General information

NPI: 1922168558
Provider Name (Legal Business Name): NEPHROLOGY AND HYPERTENSION ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 STRAITS TPKE
MIDDLEBURY CT
06762-2843
US

IV. Provider business mailing address

850 STRAITS TPKE
MIDDLEBURY CT
06762-2843
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-1800
  • Fax: 203-758-1804
Mailing address:
  • Phone: 203-758-1800
  • Fax: 203-758-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A ROER
Title or Position: SECRETARY TREASURER
Credential: MD
Phone: 203-758-1800