Healthcare Provider Details

I. General information

NPI: 1932479409
Provider Name (Legal Business Name): OPTIMUS HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BLACK ROCK AVE
BRIDGEPORT CT
06605-1200
US

IV. Provider business mailing address

982 E MAIN ST
BRIDGEPORT CT
06608-1913
US

V. Phone/Fax

Practice location:
  • Phone: 203-579-5000
  • Fax: 203-332-0376
Mailing address:
  • Phone: 203-696-3260
  • Fax: 203-332-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number0388
License Number StateCT

VIII. Authorized Official

Name: LUDWIG SPINELLI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 203-696-3260