Healthcare Provider Details

I. General information

NPI: 1265144935
Provider Name (Legal Business Name): TPTC-NH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 SHERMAN AVENUE LOWER LEVEL
NEW HAVEN CT
06511-5238
US

IV. Provider business mailing address

92 MACINTOSH WAY
SOUTHINGTON CT
06489-2055
US

V. Phone/Fax

Practice location:
  • Phone: 203-565-5104
  • Fax: 860-826-4762
Mailing address:
  • Phone: 203-565-5104
  • Fax: 860-826-4762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERIC VOIDE
Title or Position: MANAGER
Credential:
Phone: 203-565-5104