Provider Demographics
NPI:1023340064
Name:TORY Z WESTBROOK MD LLC
Entity type:Organization
Organization Name:TORY Z WESTBROOK MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:TORY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:WESTBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-759-3599
Mailing Address - Street 1:1107 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2631
Mailing Address - Country:US
Mailing Address - Phone:860-759-3599
Mailing Address - Fax:
Practice Address - Street 1:1107 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2631
Practice Address - Country:US
Practice Address - Phone:860-759-3599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT930000805OtherPTAN
CTH47372Medicare UPIN