Healthcare Provider Details

I. General information

NPI: 1992840623
Provider Name (Legal Business Name): ROBIN ZADROGA ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 BROAD ST
NEW LONDON CT
06320-2543
US

IV. Provider business mailing address

143 BLACK POINT RD
NIANTIC CT
06357-2932
US

V. Phone/Fax

Practice location:
  • Phone: 860-447-8558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000194
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: