Basic Information
| Provider Information | |||||||||
| NPI: | 1811318785 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONNECTICUT ORTHOPAEDIC SPECIALISTS OUTPATIENT SURGICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 YALE AVE | ||||||||
| Address2: | |||||||||
| City: | WALLINGFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064921838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036260160 | ||||||||
| FaxNumber: | 2032946734 | ||||||||
| Practice Location | |||||||||
| Address1: | 84 N MAIN ST BLDG 2 | ||||||||
| Address2: | |||||||||
| City: | BRANFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064053061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034832024 | ||||||||
| FaxNumber: | 2034832520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2013 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | ELIA | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2034073576 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 261QA1903X | 0334 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.