Active NPI
Tyler J Robles
- Physician Assistant
- Old Saybrook, CT
National Provider Identifier
1720840747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 599 Middlesex Tpke
Old Saybrook, CT 06475-1201 - Phone
- (844) 482-7285
- NPI assigned
- Jan 25, 2024
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
599 Middlesex Tpke
Old Saybrook, CT 06475-1201
Mailing address
6 Research Dr Ste 105
Shelton, CT 06484-6296
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240610001723 | CT | Practitioner - Physician Assistant | 5496297160 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- trobles@vascularexperts.directbygreenway.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717459200000",
"number": "1720840747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 RESEARCH DR STE 105",
"city": "SHELTON",
"state": "CT",
"postal_code": "064846296"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "599 MIDDLESEX TPKE",
"city": "OLD SAYBROOK",
"state": "CT",
"postal_code": "064751201",
"telephone_number": "844-482-7285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBLES",
"first_name": "TYLER",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-25",
"last_updated": "2024-06-04",
"certification_date": "2024-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Old Saybrook, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.