1790828184 NPI number — FAMILY ORTHOPAEDICS, LLC

Table of content: (NPI 1790828184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790828184 NPI number — FAMILY ORTHOPAEDICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY ORTHOPAEDICS, LLC
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:
1790828184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 BOSTON POST RD
Provider Second Line Business Mailing Address:
SUITE 201-B
Provider Business Mailing Address City Name:
GUILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06437-2450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-453-1088
Provider Business Mailing Address Fax Number:
203-458-2980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 VILLAGE ST
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
NORTH HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06473-3828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-453-1088
Provider Business Practice Location Address Fax Number:
203-458-2980
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARSH
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
SCHUYLER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
203-453-1088

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  028508 , 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)

  • Identifier: S383492 . This is a "AMERICAN IMAGING" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V6915 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1092212 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1754659 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 485315 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010028508CT09 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0181552 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2564839 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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