Provider Demographics
NPI:1467672022
Name:CONNECTICUT NEUROSCIENCE, PC
Entity Type:Organization
Organization Name:CONNECTICUT NEUROSCIENCE, PC
Other - Org Name:CONNECTICUT NEUROSURGERY, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-781-3400
Mailing Address - Street 1:230 GEORGE ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3224
Mailing Address - Country:US
Mailing Address - Phone:203-781-3400
Mailing Address - Fax:203-781-3414
Practice Address - Street 1:230 GEORGE ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3224
Practice Address - Country:US
Practice Address - Phone:203-781-3400
Practice Address - Fax:203-781-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT34941332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1710993381OtherNPI
CT1053562926OtherNPI
CT1477568053OtherNPI
CT1417962093OtherNPI
CT1831127265OtherNPI
CT1659387256OtherNPI
CT1548275092OtherNPI
CT165938756OtherNPI
CT1952317521OtherNPI
CT1295741825OtherNPI
CT1366591778OtherNPI
CT1649286220OtherNPI
CT1356357933OtherNPI
CT1548275092OtherNPI
CT1417962093OtherNPI