Provider Demographics
NPI:1710166863
Name:HARTFORD ORTHOTICS, LLC
Entity Type:Organization
Organization Name:HARTFORD ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-670-5874
Mailing Address - Street 1:2842 MAIN ST
Mailing Address - Street 2:#212
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:860-670-5874
Mailing Address - Fax:
Practice Address - Street 1:51 SHUNPIKE RD
Practice Address - Street 2:SUITE 41
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2497
Practice Address - Country:US
Practice Address - Phone:860-635-7653
Practice Address - Fax:860-635-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT444102335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004245511Medicaid
CTCW0774OtherHEALTHNET
CTN292377OtherWELLCARE
CT12DME0838CT01OtherANTHEM
CT5112180001Medicare NSC