NPIMap

Organization Active NPI

Connecticut Asthma & Allergy Center LLC

  • Clinical & Laboratory Immunology (Allergy & Immunology) Physician
  • West Hartford, CT
National Provider Identifier
1386604270
Registry record updated Sep 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical & Laboratory Immunology (Allergy & Immunology) PhysicianTaxonomy code 207KI0005X
Legal business name
CONNECTICUT ASTHMA & ALLERGY CENTER LLC
Practice address
836 Farmington Ave
Suite 207
West Hartford, CT 06119
Phone
(860) 232-9911
Fax
(860) 233-5996
NPI assigned
Mar 24, 2006
Last updated
Sep 28, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2011

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

Authorized official

Name
Marshall P Grodofsky, MDNPI 1841271699
Title
Physician Member
Phone
(860) 232-9911

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical & Laboratory Immunology (Allergy & Immunology) Physician 207KI0005X NU Primary

Addresses

Primary practice location

836 Farmington Ave
Suite 207
West Hartford, CT 06119

Mailing address

836 Farmington Ave
Suite 207
West Hartford, CT 06119
Phone (860) 232-9911

Other identifiers 1

IdentifierTypeStateIssuer
043518OtherAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040510000851 CT Part B Supplier - Clinic/Group Practice 4082603543 Receives reassigned benefits from 11 practitioners
Practice locations: Middletown, CT; West Hartford, CT; Manchester, CT; Hamden, CT; Avon, CT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D0920641Connecticut Asthma & Allergy Ctr, LLC836 Farmington Avenue, Ste #207, West Hartford, CT 06119Provider-performed microscopyOct 7, 2026

National Provider Directory

National Provider Directory

Locations

64 Palomba Dr
Ste 2
Enfield, CT 06082
Phone (413) 244-0091

2447 Whitney Ave
Ste 103
Hamden, CT 06518

483 Middle Tpke W
Ste 323
Manchester, CT 06040
Phone (860) 649-0601

945 Main St
Ste 308
Manchester, CT 06040
Phone (860) 232-9911

535 Saybrook Rd
Lowr
Middletown, CT 06457
Phone (860) 232-9911

535 Saybrook Rd
Ste 200
Middletown, CT 06457
Phone (860) 344-0562

225 Hopmeadow St
Ste 300
Weatogue, CT 06089
Phone (860) 232-9911

836 Farmington Ave
Ste 207
West Htfd, CT 06119
Phone (860) 232-9911

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317168000000",
    "number": "1386604270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 FARMINGTON AVE",
            "address_2": "SUITE 207",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "06119",
            "telephone_number": "860-232-9911",
            "fax_number": "860-233-5996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 FARMINGTON AVE",
            "address_2": "SUITE 207",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "06119",
            "telephone_number": "860-232-9911",
            "fax_number": "860-233-5996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT ASTHMA & ALLERGY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2011-09-28",
        "status": "A",
        "authorized_official_last_name": "GRODOFSKY",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PHYSICIAN MEMBER",
        "authorized_official_telephone_number": "860-232-9911",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207KI0005X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Clinical & Laboratory Immunology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "043518",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.