Basic Information
| Provider Information | |||||||||
| NPI: | 1700129624 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROSURGERY, ORTHOPAEDICS & SPINE SPECIALISTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 CHASE PKWY | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067083346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037556677 | ||||||||
| FaxNumber: | 2037557166 | ||||||||
| Practice Location | |||||||||
| Address1: | 690 MAIN ST S | ||||||||
| Address2: | |||||||||
| City: | SOUTHBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064882267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037556677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 06/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | GODBURN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR - COO | ||||||||
| AuthorizedOfficialTelephone: | 2035736434 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 207T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.