Basic Information
| Provider Information | |||||||||
| NPI: | 1659685832 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE ORTHOPAEDIC GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 WHITNEY AVE | ||||||||
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| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065113786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038656784 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 COMMERCE PARK | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064603551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038656784 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2010 | ||||||||
| LastUpdateDate: | 10/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | REZNIK | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | MARK | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2038656784 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.