Basic Information
| Provider Information | |||||||||
| NPI: | 1194773382 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONNECTICUT ORTHOPAEDIC AND HAND SURGERY CENTER, P.C. | ||||||||
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| OtherOrganizationName: | CONNECTICUT SPORTS MEDICINE & ORTHOPAEDIC CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 EAST RIVER DR. | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061087301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602824133 | ||||||||
| FaxNumber: | 8602890742 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 FOUNDERS ST. | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | WILLIMANTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604563997 | ||||||||
| FaxNumber: | 8604507323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | SCARANGELLA | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8604563997 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 004395308 | 05 | CT | MEDICAID |