Provider Demographics
NPI:1487752770
Name:LAVORGNA, ANTHONY ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ANDREW
Last Name:LAVORGNA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:46 PRINCE STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513
Mailing Address - Country:US
Mailing Address - Phone:203-562-0656
Mailing Address - Fax:203-562-0657
Practice Address - Street 1:46 PRINCE STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513
Practice Address - Country:US
Practice Address - Phone:203-562-0656
Practice Address - Fax:203-562-0657
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004172855Medicaid
CT061484217Medicare UPIN
CT350000913Medicare PIN