Basic Information
Provider Information
NPI: 1548242977
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KVETON
FirstName: JOHN
MiddleName: F
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 31 BROADWAY
Address2:  
City: NORTH HAVEN
State: CT
PostalCode: 064732304
CountryCode: US
TelephoneNumber: 2032341324
FaxNumber: 2032393047
Practice Location
Address1: 46 PRINCE ST
Address2:  
City: NEW HAVEN
State: CT
PostalCode: 065191600
CountryCode: US
TelephoneNumber: 2037521726
FaxNumber: 2037521838
Other Information
ProviderEnumerationDate: 11/21/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000X025566CTY Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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