Healthcare Provider Details

I. General information

NPI: 1861552366
Provider Name (Legal Business Name): ROBERT M SPITZ ,MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 MONTAUK AVE
NEW LONDON CT
06320-4706
US

IV. Provider business mailing address

342 MONTAUK AVE
NEW LONDON CT
06320-4706
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-9646
  • Fax: 860-439-0747
Mailing address:
  • Phone: 860-442-9646
  • Fax: 860-439-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT M SPITZ
Title or Position: OWNE
Credential: MD
Phone: 860-442-9646