Provider Demographics
NPI: | 1932614450 |
---|---|
Name: | CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC |
Entity Type: | Organization |
Organization Name: | CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC |
Other - Org Name: | CONNECTICUT ORTHOPAEDICS |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUSAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BADER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 203-407-3577 |
Mailing Address - Street 1: | 2408 WHITNEY AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | HAMDEN |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06518-3209 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 203-626-0160 |
Mailing Address - Fax: | 203-294-6734 |
Practice Address - Street 1: | 1055 POST RD STE 4 |
Practice Address - Street 2: | |
Practice Address - City: | FAIRFIELD |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06824-6019 |
Practice Address - Country: | US |
Practice Address - Phone: | 203-254-1055 |
Practice Address - Fax: | 203-452-3099 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-12-06 |
Last Update Date: | 2022-04-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty | |
No | 111NS0005X | Chiropractic Providers | Chiropractor | Sports Physician | Group - Multi-Specialty |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2081S0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Multi-Specialty |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |