Provider Demographics
NPI:1972127678
Name:SOUND RECOVERY, INC
Entity type:Organization
Organization Name:SOUND RECOVERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-535-3103
Mailing Address - Street 1:110 PELLEGRINO RD
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-2129
Mailing Address - Country:US
Mailing Address - Phone:860-535-3103
Mailing Address - Fax:
Practice Address - Street 1:110 PELLEGRINO RD
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-2129
Practice Address - Country:US
Practice Address - Phone:860-535-3103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty