Provider Demographics
NPI: | 1205358272 |
---|---|
Name: | CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC |
Entity Type: | Organization |
Organization Name: | CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC |
Other - Org Name: | CONNECTICUT ORTHOPAEDICS |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUSAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BADER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 203-407-3577 |
Mailing Address - Street 1: | 2408 WHITNEY AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | HAMDEN |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06518-3209 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 203-626-0160 |
Mailing Address - Fax: | 203-294-6734 |
Practice Address - Street 1: | 701 N COLONY RD |
Practice Address - Street 2: | |
Practice Address - City: | WALLINGFORD |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06492-2407 |
Practice Address - Country: | US |
Practice Address - Phone: | 203-265-1800 |
Practice Address - Fax: | 203-284-9010 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-07-12 |
Last Update Date: | 2022-04-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CT | 37864 | 207LP2900X |
207X00000X, 207XP3100X, 207XS0106X, 207XS0114X, 207XS0117X, 207XX0004X, 207XX0005X, 332B00000X, 363AM0700X | ||
CT | 39852 | 208100000X |
CT | 576 | 213E00000X, 213ES0103X |
CT | 747 | 213ES0131X |
CT | 3013 | 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
No | 207XP3100X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
No | 213ES0131X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | Group - Multi-Specialty |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |