Provider Demographics
NPI:1245409556
Name:ORTHOPEDIC SERVICES OF BPT PC
Entity Type:Organization
Organization Name:ORTHOPEDIC SERVICES OF BPT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-381-9670
Mailing Address - Street 1:160 HAWLEY LANE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611
Mailing Address - Country:US
Mailing Address - Phone:203-381-9670
Mailing Address - Fax:203-381-9669
Practice Address - Street 1:160 HAWLEY LANE
Practice Address - Street 2:SUITE 201
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611
Practice Address - Country:US
Practice Address - Phone:203-381-9670
Practice Address - Fax:203-381-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013045207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001130459Medicaid
D02435Medicare UPIN
200000110Medicare Oscar/Certification
0273920001Medicare NSC