Provider Demographics
NPI:1235204009
Name:NORTHEAST ORTHOPAEDIC & HAND SURGERY PC
Entity Type:Organization
Organization Name:NORTHEAST ORTHOPAEDIC & HAND SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:HENDRIKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-755-9166
Mailing Address - Street 1:60 WESTWOOD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-755-9166
Mailing Address - Fax:203-755-5932
Practice Address - Street 1:60 WESTWOOD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-755-9166
Practice Address - Fax:203-755-5932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0378540001Medicare NSC
CTC01826Medicare PIN