Provider Demographics
NPI:1881657039
Name:CENTRAL CONNECTICUT REHAB MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:CENTRAL CONNECTICUT REHAB MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-832-6248
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-0337
Mailing Address - Country:US
Mailing Address - Phone:860-832-6248
Mailing Address - Fax:860-229-5526
Practice Address - Street 1:281 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4971
Practice Address - Country:US
Practice Address - Phone:860-582-4999
Practice Address - Fax:860-585-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01627Medicare PIN