Provider Demographics
NPI:1184783102
Name:ROBBINS MEDICAL, P.C.
Entity type:Organization
Organization Name:ROBBINS MEDICAL, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-347-5333
Mailing Address - Street 1:85 CHURCH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3647
Mailing Address - Country:US
Mailing Address - Phone:860-347-5333
Mailing Address - Fax:860-346-3517
Practice Address - Street 1:85 CHURCH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3647
Practice Address - Country:US
Practice Address - Phone:860-347-5333
Practice Address - Fax:860-346-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207Q00000X, 363LF0000X, 363LA2100X, 207R00000X
CT004748163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4251253Medicaid
CTC02641Medicare PIN