Provider Demographics
NPI:1710238563
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 FINANCIAL 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 1:74 BATTERSON PARK RD STE 107
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2565
Mailing Address - Country:US
Mailing Address - Phone:860-549-8276
Mailing Address - Fax:860-244-1075
Practice Address - Street 1:201 N MOUNTAIN RD STE 302
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1848
Practice Address - Country:US
Practice Address - Phone:860-549-3210
Practice Address - Fax:860-223-7273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00413Medicare PIN