Provider Demographics
NPI:1669653283
Name:CENTRAL CONNECTICUT NEUROSURGERY AND SPINE LLC
Entity Type:Organization
Organization Name:CENTRAL CONNECTICUT NEUROSURGERY AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-225-1227
Mailing Address - Street 1:1 LIBERTY SQ FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2637
Mailing Address - Country:US
Mailing Address - Phone:860-225-1227
Mailing Address - Fax:860-225-1253
Practice Address - Street 1:1 LIBERTY SQ FL 1
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2637
Practice Address - Country:US
Practice Address - Phone:860-225-1227
Practice Address - Fax:860-225-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039336207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCO3839OtherMEDICARE PTAN