Provider Demographics
NPI:1538503875
Name:ORTHOCONNECTICUT, PC
Entity Type:Organization
Organization Name:ORTHOCONNECTICUT, PC
Other - Org Name:DANBURY ORTHOPEDICS, NEW MILFORD ORTHOPEDICS, COASTAL ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-797-1500
Mailing Address - Street 1:131 KENT RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3485
Mailing Address - Country:US
Mailing Address - Phone:860-355-8000
Mailing Address - Fax:860-350-6291
Practice Address - Street 1:153 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2791
Practice Address - Country:US
Practice Address - Phone:860-355-8000
Practice Address - Fax:860-350-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0423250010Medicare NSC