Provider Demographics
NPI:1083797401
Name:ACTIVE ORTHOPAEDICS PC
Entity Type:Organization
Organization Name:ACTIVE ORTHOPAEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-758-1272
Mailing Address - Street 1:1579 STRAITS TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762
Mailing Address - Country:US
Mailing Address - Phone:203-758-1272
Mailing Address - Fax:203-758-1070
Practice Address - Street 1:1579 STRAITS TURNPIKE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762
Practice Address - Country:US
Practice Address - Phone:203-758-1272
Practice Address - Fax:203-758-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034194207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F40857Medicare UPIN
C02444Medicare ID - Type Unspecified