Healthcare Provider Details

I. General information

NPI: 1609794304
Provider Name (Legal Business Name): SAMSON TONTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 HUNTERS AVE APT 1
TAFTVILLE CT
06380-1034
US

IV. Provider business mailing address

72 HUNTERS AVE APT 1
TAFTVILLE CT
06380-1034
US

V. Phone/Fax

Practice location:
  • Phone: 860-710-0029
  • Fax:
Mailing address:
  • Phone: 860-710-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberBY16986
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: