Provider Demographics
NPI:1376137471
Name:ORTHOPAEDIC & NEUROSURGERY SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC & NEUROSURGERY SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-869-1145
Mailing Address - Street 1:5 HIGH RIDGE PARK FL 2
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1332
Mailing Address - Country:US
Mailing Address - Phone:203-869-1145
Mailing Address - Fax:203-618-1721
Practice Address - Street 1:5 PEQUOT PARK ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-2856
Practice Address - Country:US
Practice Address - Phone:860-399-0245
Practice Address - Fax:860-894-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004395217Medicaid