Provider Demographics
NPI:1912602475
Name:CONNECTICUT ADVANCED SPINE LLC
Entity Type:Organization
Organization Name:CONNECTICUT ADVANCED SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-639-2862
Mailing Address - Street 1:8 BANBURY CRES
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1187
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:169 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-7404
Practice Address - Country:US
Practice Address - Phone:475-337-7463
Practice Address - Fax:833-449-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty