Healthcare Provider Details

I. General information

NPI: 1538322110
Provider Name (Legal Business Name): WASKOWITZ ORTHOPAEDICS & SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HART ST BLDG. B
NEW BRITAIN CT
06052-1743
US

IV. Provider business mailing address

40 HART ST BLDG. B
NEW BRITAIN CT
06052-1743
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-6709
  • Fax: 860-223-7915
Mailing address:
  • Phone: 860-224-6709
  • Fax: 860-223-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT S. WASKOWITZ
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 860-224-6709