Basic Information
| Provider Information | |||||||||
| NPI: | 1912381625 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC | ||||||||
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| OtherOrganizationName: | CENTER FOR ORTHOPAEDICS A DIVISION OF CONNECTICUT ORTHOPAEDIC SPECIALI | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2408 WHITNEY AVE | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034073500 | ||||||||
| FaxNumber: | 2032811164 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 EAST AVE | ||||||||
| Address2: | SUITE 2E | ||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068515721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037523100 | ||||||||
| FaxNumber: | 2037529291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2015 | ||||||||
| LastUpdateDate: | 03/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | ELIA | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2034073500 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CONNECTICUT ORTHOPAEDIC SPECIALISTS, PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.