Provider Demographics
NPI:1851310031
Name:ORTHOPAEDIC SPORTS SPECIALISTS, PC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPORTS SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-652-8883
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-0643
Mailing Address - Country:US
Mailing Address - Phone:860-652-8883
Mailing Address - Fax:860-652-8887
Practice Address - Street 1:84 GLASTONBURY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4468
Practice Address - Country:US
Practice Address - Phone:860-652-8883
Practice Address - Fax:860-652-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03222Medicare ID - Type UnspecifiedGROUP NUMBER
CT5329590001Medicare NSC