1194773382 NPI number — CONNECTICUT ORTHOPAEDIC AND HAND SURGERY CENTER, P.C.

Table of content: (NPI 1194773382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194773382 NPI number — CONNECTICUT ORTHOPAEDIC AND HAND SURGERY CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT ORTHOPAEDIC AND HAND SURGERY CENTER, P.C.
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:
Provider Other Organization Name Type Code:
6
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:
1194773382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 EAST RIVER DR.
Provider Second Line Business Mailing Address:
5TH FLOOR
Provider Business Mailing Address City Name:
EAST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06108-7301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-282-4133
Provider Business Mailing Address Fax Number:
860-289-0742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 FOUNDERS ST.
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WILLIMANTIC
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-456-3997
Provider Business Practice Location Address Fax Number:
860-450-7323
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCARANGELLA
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
860-456-3997

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004395308 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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