Healthcare Provider Details

I. General information

NPI: 1487964599
Provider Name (Legal Business Name): ORTHOPEDIC SURGICAL PARTNERS, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ENSIGN DR
AVON CT
06001-3773
US

IV. Provider business mailing address

1111 CROMWELL AVE STE 403
ROCKY HILL CT
06067-3454
US

V. Phone/Fax

Practice location:
  • Phone: 860-751-6039
  • Fax: 860-409-0714
Mailing address:
  • Phone: 860-525-4469
  • Fax: 860-999-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number15927
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number22280
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number34572
License Number StateCT

VIII. Authorized Official

Name: ROBERT MCALLISTER
Title or Position: PRESIDENT
Credential: MD
Phone: 860-525-4469