Provider Demographics
NPI:1619040631
Name:TED STRAYER DO PC
Entity Type:Organization
Organization Name:TED STRAYER DO PC
Other - Org Name:PROFESSIONAL CORP NAME
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:STRAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-281-5468
Mailing Address - Street 1:2440 WHITNEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518
Mailing Address - Country:US
Mailing Address - Phone:203-281-5468
Mailing Address - Fax:203-288-5275
Practice Address - Street 1:2440 WHITNEY AVENUE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518
Practice Address - Country:US
Practice Address - Phone:203-281-5468
Practice Address - Fax:203-288-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000269208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
250000089Medicare ID - Type Unspecified
D88827Medicare UPIN