Provider Demographics
NPI:1114047933
Name:ELITE BRAIN & SPINE OF CONNECTICUT, PLLC
Entity Type:Organization
Organization Name:ELITE BRAIN & SPINE OF CONNECTICUT, PLLC
Other - Org Name:NEUROSURGICAL ASSOCIATES OF SOUTHWESTERN CT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:B
Authorized Official - Last Name:FINNEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-853-0003
Mailing Address - Street 1:33 HOSPITAL AVE.
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-853-0003
Mailing Address - Fax:203-838-5423
Practice Address - Street 1:33 HOSPITAL AVE.
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-853-0003
Practice Address - Fax:203-838-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6072270001Medicare NSC
CTC02331Medicare PIN