Provider Demographics
NPI:1285676825
Name:ORTHOPEDIC ASSOCIATES OF CENTRAL CONNECTICUT, PC
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF CENTRAL CONNECTICUT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-243-1414
Mailing Address - Street 1:510 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3123
Mailing Address - Country:US
Mailing Address - Phone:860-243-1414
Mailing Address - Fax:860-286-0510
Practice Address - Street 1:510 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002
Practice Address - Country:US
Practice Address - Phone:860-243-1414
Practice Address - Fax:860-286-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004001681Medicaid
C00119Medicare ID - Type Unspecified
CT004001681Medicaid