Individual
LAWRENCE RIFKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
580 COTTAGE GROVE RD STE 103, BLOOMFIELD, CT 06002-3088
(860) 243-5225
(860) 769-6757
Mailing address
291 STANLEY DR, GLASTONBURY, CT 06033-2621
(860) 918-1275
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
032317
CT
2080A0000X
Pediatric Adolescent Medicine Physician
032317
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001323170
—
CT
01
—
010032317CT03
ANTHEM BLUE SHIELD
CT
Enumeration date
07/26/2006
Last updated
08/01/2024
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