Provider Demographics
NPI:1467082966
Name:NEUROSURGERY, ORTHOPAEDICS & SPINE SPECIALISTS, PC
Entity Type:Organization
Organization Name:NEUROSURGERY, ORTHOPAEDICS & SPINE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GODBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-755-6677
Mailing Address - Street 1:2 IVY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6416
Mailing Address - Country:US
Mailing Address - Phone:203-755-6677
Mailing Address - Fax:203-755-7166
Practice Address - Street 1:2 IVY BROOK RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6416
Practice Address - Country:US
Practice Address - Phone:203-755-6677
Practice Address - Fax:203-755-7166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROSURGERY, ORTHOPAEDICS & SPINE SPECIALISTS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty