Provider Demographics
NPI:1558474742
Name:MIDDLESEX ORTHOPEDIC SURGEONS PC
Entity Type:Organization
Organization Name:MIDDLESEX ORTHOPEDIC SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-685-8940
Mailing Address - Street 1:410 SAYBROOK RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4780
Mailing Address - Country:US
Mailing Address - Phone:860-685-8940
Mailing Address - Fax:
Practice Address - Street 1:410 SAYBROOK RD
Practice Address - Street 2:STE 100
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4780
Practice Address - Country:US
Practice Address - Phone:860-685-8940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT174400000X
207X00000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004000469Medicaid
F23850Medicare UPIN
CT004000469Medicaid
CT0454610001Medicare NSC
E93785Medicare UPIN
G96890Medicare UPIN
Q61377Medicare UPIN
CTC00240Medicare ID - Type Unspecified