1114047933 NPI number — ELITE BRAIN & SPINE OF CONNECTICUT, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114047933 NPI number — ELITE BRAIN & SPINE OF CONNECTICUT, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE BRAIN & SPINE OF CONNECTICUT, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEUROSURGICAL ASSOCIATES OF SOUTHWESTERN CT
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114047933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 HOSPITAL AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-853-0003
Provider Business Mailing Address Fax Number:
203-838-5423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 HOSPITAL AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-853-0003
Provider Business Practice Location Address Fax Number:
203-838-5423
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FINNEGAN
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-853-0003

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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