Basic Information
| Provider Information | |||||||||
| NPI: | 1316038623 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ORTHOPAEDIC SURGERY & SPORTS MEDICINE CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 166 CHERRY ST STE 4400 | ||||||||
| Address2: | |||||||||
| City: | NEW CANAAN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068404828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033237331 | ||||||||
| FaxNumber: | 2033247027 | ||||||||
| Practice Location | |||||||||
| Address1: | 166 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | NEW CANAAN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068404828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033237331 | ||||||||
| FaxNumber: | 2033247027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | BROOKS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2033237331 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 025754 | CT | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 207X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208100000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 261QX0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 207XS0106X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.