Provider Demographics
NPI:1235589292
Name:ROBINSON, LENESE (LMT)
Entity Type:Individual
Prefix:MR
First Name:LENESE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 QUINSIGAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3004
Mailing Address - Country:US
Mailing Address - Phone:203-435-6468
Mailing Address - Fax:203-435-6468
Practice Address - Street 1:503 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2673
Practice Address - Country:US
Practice Address - Phone:203-441-4371
Practice Address - Fax:203-441-4375
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty