Provider Demographics
NPI:1780758219
Name:ATG CONNECTICUT INC
Entity type:Organization
Organization Name:ATG CONNECTICUT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR MGR LICENSING & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLESCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-447-7515
Mailing Address - Street 1:805 BROOK ST STE 402
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3431
Mailing Address - Country:US
Mailing Address - Phone:314-447-7500
Mailing Address - Fax:
Practice Address - Street 1:714 BROOK ST STE 150
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3435
Practice Address - Country:US
Practice Address - Phone:860-761-0700
Practice Address - Fax:860-761-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1168762OtherAETNA
CT4197382Medicaid
CT4295OtherMOHAWK VALLEY PHY HEALTHP
CT799116-5637OtherCONNECTICARE
ANC1783OtherOXFORD HEALTH PLANS
CT419738200OtherBLUE CARE FAMILY PLAN
CT12DME0165CT01OtherBC BS CONNECTICUT
CT642264OtherVOCATIONAL EDUCATIONAL
CT0V7875OtherHEALTHNET
10042412OtherCAPITOL DISTRICT PHY HP
CT81194OtherNORTHWOOD NPN
12DME0165CT01OtherBC BS -FEDERAL
CT4197382Medicaid