Healthcare Provider Details

I. General information

NPI: 1164697645
Provider Name (Legal Business Name): ORTHOCARE SPECIALISTS ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 MAIN ST
BRIDGEPORT CT
06606-1804
US

IV. Provider business mailing address

4747 MAIN ST
BRIDGEPORT CT
06606-1804
US

V. Phone/Fax

Practice location:
  • Phone: 203-372-0649
  • Fax: 203-373-0376
Mailing address:
  • Phone: 203-372-0649
  • Fax: 203-373-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0522562
License Number StateCT

VIII. Authorized Official

Name: MS. ALICE CRONIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 203-372-0649