Ian Brokaw, DPT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

10642 Issued in CT

Practice address

65 Albany Tpke
Canton, CT 06019-2507

Phone

(860) 693-6226

Fax

(860) 693-8002

NPI assigned

Apr 16, 2018

Last updated

Apr 16, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523836800000",
    "number": "1356838262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 466",
            "city": "CANTON",
            "state": "CT",
            "postal_code": "060190466",
            "telephone_number": "860-693-6226",
            "fax_number": "860-693-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 ALBANY TPKE",
            "city": "CANTON",
            "state": "CT",
            "postal_code": "060192507",
            "telephone_number": "860-693-6226",
            "fax_number": "860-693-8002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROKAW",
        "first_name": "IAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-16",
        "last_updated": "2018-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "CT",
            "license": "10642",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CT",
            "license": "10642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles A. Bonelli, O.D.
• Christopher C. Bonelli, O.D.
• Isaac J Bosco, DMD
• Melissa Wooldridge Breton, APRN
• Rebecca Desautels Brickman
• Carolyn Brown, OTD, OTR/L
• Jennifer Cannon, APRN
• Canton Geriatrics PLLC
• Canton Interventional Radiologist Group PC
• Canton Physical Therapy, LLC

• Physical Medicine & Rehabilitation Physician in Canton, CT
• Providers in Canton, CT by specialty
• Physical Medicine & Rehabilitation Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.