Provider Demographics
NPI:1346246931
Name:PHYSICAL MEDICINE & REHABILITATION OF HARTFORD LLC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE & REHABILITATION OF HARTFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-243-3434
Mailing Address - Street 1:35 JOLLEY DR
Mailing Address - Street 2:STE 101
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3062
Mailing Address - Country:US
Mailing Address - Phone:860-243-3434
Mailing Address - Fax:860-243-0208
Practice Address - Street 1:35 JOLLEY DR
Practice Address - Street 2:STE 101
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002
Practice Address - Country:US
Practice Address - Phone:860-243-3434
Practice Address - Fax:860-243-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035179208100000X, 2081N0008X, 2081P0010X, 261QR0400X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004251302Medicaid
CTC03305Medicare ID - Type Unspecified