Provider Demographics
NPI:1578860334
Name:ORTHOPEDIC ASSOCIATES OF HARTFORD,PC
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF HARTFORD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUDANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-549-8279
Mailing Address - Street 1:270 FARMINGTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1909
Mailing Address - Country:US
Mailing Address - Phone:860-549-8276
Mailing Address - Fax:860-674-8084
Practice Address - Street 1:100 HAZARD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5446
Practice Address - Country:US
Practice Address - Phone:860-549-3210
Practice Address - Fax:860-247-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty