Provider Demographics
NPI:1619374204
Name:KLUG, JOEL (CVRT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:KLUG
Suffix:
Gender:M
Credentials:CVRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 NICHOLS ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3282
Mailing Address - Country:US
Mailing Address - Phone:802-558-5735
Mailing Address - Fax:
Practice Address - Street 1:950 CAMPBELL AVE.
Practice Address - Street 2:VA CONNECTICUT
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind