Provider Demographics
NPI:1831641067
Name:MORONG, ROBERT III (ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MORONG
Suffix:III
Gender:M
Credentials:ATC
Other - Prefix:MR
Other - First Name:ROBBIE
Other - Middle Name:
Other - Last Name:MORONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:35 WOODSEDGE DR
Mailing Address - Street 2:APT 6B
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:207-318-1052
Mailing Address - Fax:
Practice Address - Street 1:35 WOODSEDGE DR
Practice Address - Street 2:APT 6B
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4282
Practice Address - Country:US
Practice Address - Phone:207-318-1052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer