Provider Demographics
| NPI: | 1609167261 |
|---|---|
| Name: | CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC |
| Entity type: | Organization |
| Organization Name: | CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SUSAN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | BADER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 203-407-3577 |
| Mailing Address - Street 1: | 2408 WHITNEY AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HAMDEN |
| Mailing Address - State: | CT |
| Mailing Address - Zip Code: | 06518-3209 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 203-626-0160 |
| Mailing Address - Fax: | 203-294-6734 |
| Practice Address - Street 1: | 84 N MAIN ST BLDG 2 |
| Practice Address - Street 2: | |
| Practice Address - City: | BRANFORD |
| Practice Address - State: | CT |
| Practice Address - Zip Code: | 06405-3061 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 203-483-2024 |
| Practice Address - Fax: | 203-483-2520 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2011-04-29 |
| Last Update Date: | 2024-05-29 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | Group - Multi-Specialty |
| No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207XP3100X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery | Group - Multi-Specialty |
| No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
| No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Multi-Specialty |
| No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
| No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
| No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CT | C00470 | Other | MEDICARE GROUP NUMBER |
| CT | 0334 | Other | STATE OF CT OUTPATIENT SURGICAL FACILITY LICENSE |
| CT | 0334 | Other | STATE OF CT OUTPATIENT SURGICAL FACILITY LICENSE |
