1366731929 NPI number — ORTHOPEDIC ASSOCIATES OF HARTFORD,PC

Table of content: (NPI 1366731929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366731929 NPI number — ORTHOPEDIC ASSOCIATES OF HARTFORD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC ASSOCIATES OF HARTFORD,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:
Provider Other Organization Name Type Code:
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:
1366731929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 FARMINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06032-1909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-549-8276
Provider Business Mailing Address Fax Number:
860-674-8084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 ASYLUM AVE
Provider Second Line Business Practice Location Address:
SUITE 4301
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-1770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-549-3210
Provider Business Practice Location Address Fax Number:
860-247-3803
Provider Enumeration Date:
04/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MUDANO
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
860-549-8279

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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