Provider Demographics
NPI:1205154903
Name:NEUROSURGERY, ORTHOPAEDICS & SPINE SPECIALISTS, PC
Entity type:Organization
Organization Name:NEUROSURGERY, ORTHOPAEDICS & SPINE SPECIALISTS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-573-6410
Mailing Address - Street 1:500 CHASE PARKWAY
Mailing Address - Street 2:NEUROSURGERY, ORTHOPAEDICS & SPINE SPECIALISTS, PC
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3131
Mailing Address - Country:US
Mailing Address - Phone:203-573-6410
Mailing Address - Fax:203-755-7067
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3119
Practice Address - Country:US
Practice Address - Phone:203-755-7115
Practice Address - Fax:203-755-7067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045031207X00000X
CT000761225XH1200X
CT000738225XH1200X
CT004512225XH1200X
CT036792207XS0106X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6334080001Medicare NSC