Provider Demographics
NPI:1841319019
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:860-549-8276
Mailing Address - Street 1:270 FARMINGTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1909
Mailing Address - Country:US
Mailing Address - Phone:860-549-8276
Mailing Address - Fax:860-674-8084
Practice Address - Street 1:40 HART ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1743
Practice Address - Country:US
Practice Address - Phone:860-223-8553
Practice Address - Fax:860-223-7273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030915207X00000X
CT001539363AS0400X
CT19436207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00413OtherGROUP NUMBER
CT200000809Medicare PIN
CTQ33737Medicare UPIN
CTC00413OtherGROUP NUMBER
CTE84432Medicare UPIN
CT200000207Medicare PIN
CT970002708Medicare PIN