1962757591 NPI number — CONNECTICUT ORTHOPAEDIC 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 1962757591 NPI number — CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT ORTHOPAEDIC 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:
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:
1962757591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2408 WHITNEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06518-3209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-626-0160
Provider Business Mailing Address Fax Number:
203-294-6734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GREENWICH PL
Provider Second Line Business Practice Location Address:
889 BRIDGEPORT AVE
Provider Business Practice Location Address City Name:
SHELTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06484-7603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-538-0021
Provider Business Practice Location Address Fax Number:
203-538-0024
Provider Enumeration Date:
07/19/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ELIA
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
203-407-3576

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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