Basic Information
| Provider Information | |||||||||
| NPI: | 1356412779 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONNECTICUT NECK & BACK SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 HOSPITAL AVE | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068106027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032171833 | ||||||||
| FaxNumber: | 2037449702 | ||||||||
| Practice Location | |||||||||
| Address1: | 39 HOSPITAL AVE | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068106027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037449700 | ||||||||
| FaxNumber: | 2037449702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 2037449700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.