Provider Demographics
NPI:1053494385
Name:WASSERMAN, ROBERT I (RPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:I
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-224-6231
Mailing Address - Fax:860-224-6260
Practice Address - Street 1:1 LAKE ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1396
Practice Address - Country:US
Practice Address - Phone:860-348-4850
Practice Address - Fax:860-348-4854
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004128163Medicaid
CTA426869OtherOXFORD
CT1255448155OtherGHMC GROUP NPI
CT369641OtherWELLCARE MEDICARE ONLY
CT55000009OtherCIGNA
CT616784OtherCONNECTICARE
CT004264660Medicaid
CT080003744CT08OtherBCBS ID
CT104454900OtherUS DEPT OF LABOR ID
CT2587255OtherAETNA ID
CT080003744CT08OtherBC FAMILY PLAN MEDICAID
CT2V3997OtherHEALTH NET
CTC01373Medicare ID - Type UnspecifiedGHMC GROUP MEDICARE ID
CT616784OtherCONNECTICARE