Provider Demographics
NPI:1194993980
Name:WRK VENTURES, LLC
Entity type:Organization
Organization Name:WRK VENTURES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ROHATSCH
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:203-885-0808
Mailing Address - Street 1:31 OLD ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1711
Mailing Address - Country:US
Mailing Address - Phone:203-885-0808
Mailing Address - Fax:203-885-0813
Practice Address - Street 1:900 MAIN ST S
Practice Address - Street 2:SUITE 100, BUILDING 2
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4237
Practice Address - Country:US
Practice Address - Phone:203-262-1911
Practice Address - Fax:203-262-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03949Medicare PIN
CT6186790001Medicare NSC