Provider Demographics
NPI:1073884755
Name:ORTHOPEDIC ASSOCIATES OF MIDDLETOWN, PC
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF MIDDLETOWN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALAFIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-704-6021
Mailing Address - Street 1:512 SAYBROOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4788
Mailing Address - Country:US
Mailing Address - Phone:860-347-7636
Mailing Address - Fax:860-894-1882
Practice Address - Street 1:14 JONES HOLLOW RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1448
Practice Address - Country:US
Practice Address - Phone:860-295-8751
Practice Address - Fax:860-894-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004186260Medicaid
CTC02315Medicare PIN