Provider Demographics
NPI:1578670659
Name:SPORTS MEDICINE AND ORTHOPEDIC SURGERY, P.C.
Entity Type:Organization
Organization Name:SPORTS MEDICINE AND ORTHOPEDIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SMOS
Authorized Official - Prefix:DR
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:860-649-0063
Mailing Address - Street 1:360 TOLLAND TPKE
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1771
Mailing Address - Country:US
Mailing Address - Phone:860-649-0063
Mailing Address - Fax:860-643-3642
Practice Address - Street 1:360 TOLLAND TPKE
Practice Address - Street 2:SUITE 3C
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1771
Practice Address - Country:US
Practice Address - Phone:860-649-0063
Practice Address - Fax:860-643-3642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207X00000X, 207XX0005X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004188331Medicaid
1074510001Medicare NSC
CT004188331Medicaid