Provider Demographics
NPI:1225096704
Name:SPINE & SPORTS CENTER OF CONNECTICUT
Entity Type:Organization
Organization Name:SPINE & SPORTS CENTER OF CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-573-1423
Mailing Address - Street 1:500 CHASE PKWY
Mailing Address - Street 2:500 CHASE PARKWAY
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3346
Mailing Address - Country:US
Mailing Address - Phone:203-573-1167
Mailing Address - Fax:203-573-1272
Practice Address - Street 1:500 CHASE PKWY
Practice Address - Street 2:500 CHASE PARKWAY
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3346
Practice Address - Country:US
Practice Address - Phone:203-573-1167
Practice Address - Fax:203-573-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty