Active NPI
Alexander Imhof, MS,ATC, PES
- Athletic Trainer
- Waterbury, CT
National Provider Identifier
1518522069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 001175
- Practice address
- 800 Country Club Rd
Waterbury, CT 06708-3240 - Phone
- (203) 591-5231
- NPI assigned
- May 9, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 001175 | CT | Primary |
Addresses
Primary practice location
800 Country Club Rd
Waterbury, CT 06708-3240
Mailing address
28 Armstrong Rd Unit B9
Coventry, CT 06238-3366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001175 | CT | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557360000000",
"number": "1518522069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28 ARMSTRONG RD UNIT B9",
"city": "COVENTRY",
"state": "CT",
"postal_code": "062383366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 COUNTRY CLUB RD",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067083240",
"telephone_number": "203-591-5231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMHOF",
"first_name": "ALEXANDER",
"credential": "MS,ATC, PES",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-09",
"last_updated": "2019-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CT",
"license": "001175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.