MEDICARE: ORTHOCONNECTICUT, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician
2	363AS0400X	Surgical Physician Assistant
3	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1063814242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOCONNECTICUT, PC

Provider Business Mailing Address
First Line	:	761 MAIN AVE
Second Line	:	115
City	:	NORWALK
State	:	CT
Zip	:	06851-1080
Country	:	US
Telephone Number	:	203-845-2200
Fax Number	:	203-847-1940

Provider Business Practice Location Address
First Line	:	30 EAST AVE
Second Line	:
City	:	NEW CANAAN
State	:	CT
Zip	:	06840-5516
Country	:	US
Telephone Number	:	203-845-2200
Fax Number	:	203-847-1940

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL M LYNCH
Credential	:
Telephone Number	:	203-845-2200

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	04/25/2017

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