Healthcare Provider Details

I. General information

NPI: 1073399358
Provider Name (Legal Business Name): ROBERT G ZURZOLA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 COUNTRY CLUB RD
WATERBURY CT
06708-3240
US

IV. Provider business mailing address

57 GILLOTTI RD
NEW FAIRFIELD CT
06812-2521
US

V. Phone/Fax

Practice location:
  • Phone: 203-596-4566
  • Fax:
Mailing address:
  • Phone: 203-482-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: