Healthcare Provider Details

I. General information

NPI: 1598268138
Provider Name (Legal Business Name): ORTHO NEW ENGLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BANTAM RD
BANTAM CT
06750-1600
US

IV. Provider business mailing address

622 BANTAM RD
BANTAM CT
06750-1600
US

V. Phone/Fax

Practice location:
  • Phone: 860-361-6650
  • Fax: 860-361-6654
Mailing address:
  • Phone: 860-361-6650
  • Fax: 860-361-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MITCHELL GARDEN
Title or Position: PRINCIPAL PHYSICIAN
Credential: MD
Phone: 860-361-6650