Provider Demographics
NPI:1013109883
Name:CONNECTICUT INTRGRATED NEURO & SPINE
Entity Type:Organization
Organization Name:CONNECTICUT INTRGRATED NEURO & SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:AKEYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-832-4664
Mailing Address - Street 1:114 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-4223
Mailing Address - Country:US
Mailing Address - Phone:860-832-4664
Mailing Address - Fax:860-832-4665
Practice Address - Street 1:114 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-4223
Practice Address - Country:US
Practice Address - Phone:860-832-4664
Practice Address - Fax:860-832-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036406207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG36943Medicare UPIN