Basic Information
| Provider Information | |||||||||
| NPI: | 1467745679 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPORTS MEDICINE AND ORTHOPEDIC SURGERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 EAST RIVER DRIVE | ||||||||
| Address2: | 5TH FLOOR-CREDENTIALING | ||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061087301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602824137 | ||||||||
| FaxNumber: | 8602890742 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 GERBER DR | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | TOLLAND | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060842851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604540527 | ||||||||
| FaxNumber: | 8606433642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2011 | ||||||||
| LastUpdateDate: | 08/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | VELTRI | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8602824137 | ||||||||
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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 |
No ID Information.