Provider Demographics
NPI:1538415286
Name:ROFF, BRUCE KISTOPHER (LMT, DIPL AC)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:KISTOPHER
Last Name:ROFF
Suffix:
Gender:M
Credentials:LMT, DIPL AC
Other - Prefix:
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Other - Middle Name:
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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:203-740-9300
Mailing Address - Fax:
Practice Address - Street 1:31 OLD ROUTE 7
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1711
Practice Address - Country:US
Practice Address - Phone:203-740-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004050171100000X
CT000591171100000X
NY019223225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist