Provider Demographics
NPI:1235307125
Name:ORTHOPAEDIC SPECIALTY GROUP
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALTY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-337-2600
Mailing Address - Street 1:2 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4600
Mailing Address - Country:US
Mailing Address - Phone:203-944-0042
Mailing Address - Fax:203-944-5428
Practice Address - Street 1:2 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4600
Practice Address - Country:US
Practice Address - Phone:203-944-0042
Practice Address - Fax:203-944-5428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0222120001Medicare NSC
CTC00410Medicare PIN