Provider Demographics
NPI:1942423710
Name:KRAVITZ, EDWARD BARRY (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:BARRY
Last Name:KRAVITZ
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4817
Mailing Address - Country:US
Mailing Address - Phone:860-805-7259
Mailing Address - Fax:
Practice Address - Street 1:230 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3224
Practice Address - Country:US
Practice Address - Phone:203-498-5980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPROVIDER CODE 22OtherRESPIRATORY, REHABILITATI