Provider Demographics
NPI:1467745679
Name:SPORTS MEDICINE AND ORTHOPEDIC SURGERY
Entity Type:Organization
Organization Name:SPORTS MEDICINE AND ORTHOPEDIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:VELTRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-282-4137
Mailing Address - Street 1:99 EAST RIVER DRIVE
Mailing Address - Street 2:5TH FLOOR-CREDENTIALING
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7301
Mailing Address - Country:US
Mailing Address - Phone:860-282-4137
Mailing Address - Fax:860-289-0742
Practice Address - Street 1:100 GERBER DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2851
Practice Address - Country:US
Practice Address - Phone:860-454-0527
Practice Address - Fax:860-643-3642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02196Medicare PIN
CT1074510002Medicare NSC