1205154903 NPI number — NEUROSURGERY, ORTHOPAEDICS & SPINE SPECIALISTS, PC

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 1205154903 NPI number — NEUROSURGERY, ORTHOPAEDICS & SPINE SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSURGERY, ORTHOPAEDICS & SPINE SPECIALISTS, PC
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:
HAND TO SHOULDER CENTER, LLC
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:
1205154903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 CHASE PARKWAY
Provider Second Line Business Mailing Address:
NEUROSURGERY, ORTHOPAEDICS & SPINE SPECIALISTS, PC
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06708-3131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-573-6410
Provider Business Mailing Address Fax Number:
203-755-7067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1320 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-755-7115
Provider Business Practice Location Address Fax Number:
203-755-7067
Provider Enumeration Date:
05/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DOWNEY
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALLING COORDINATOR
Authorized Official Telephone Number:
203-573-6410

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  045031 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: 036792 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X , with the licence number: 000761 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , with the licence number: 000738 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , with the licence number: 004512 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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