Provider Demographics
NPI:1225329501
Name:ADVANCED ORTHOPEDICS NEW ENGLAND
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDICS NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICAH
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-728-6740
Mailing Address - Street 1:1000 ASYLUM AVE STE 2126
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1719
Mailing Address - Country:US
Mailing Address - Phone:860-728-6740
Mailing Address - Fax:860-547-1554
Practice Address - Street 1:54 W AVON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3680
Practice Address - Country:US
Practice Address - Phone:860-728-6740
Practice Address - Fax:860-547-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CT332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00117OtherMEDICARE PTAN
CTC00117OtherMEDICARE PTAN