Provider Demographics
NPI:1831102862
Name:MORTATI, JOSEPH A (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:MORTATI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4154 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3563
Mailing Address - Country:US
Mailing Address - Phone:203-372-5718
Mailing Address - Fax:203-372-0291
Practice Address - Street 1:4154 MADISON AVE
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3563
Practice Address - Country:US
Practice Address - Phone:203-372-5718
Practice Address - Fax:203-372-0291
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005669174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
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