Basic Information
| Provider Information | |||||||||
| NPI: | 1083905319 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED ORTHOPEDICS NEW ENGLAND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 ASYLUM AVE STE 2126 | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607286740 | ||||||||
| FaxNumber: | 8605471554 | ||||||||
| Practice Location | |||||||||
| Address1: | 506 CROMWELL AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060671851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607286740 | ||||||||
| FaxNumber: | 8605471554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2011 | ||||||||
| LastUpdateDate: | 03/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | KRUGER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8607286740 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 03/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 335E00000X | N | Suppliers | Prosthetic/Orthotic Supplier | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | C0117 | 01 | CT | MEDICARE | OTHER |