Healthcare Provider Details

I. General information

NPI: 1992871875
Provider Name (Legal Business Name): OPTIMUS HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 BARNUM AVE
BRIDGEPORT CT
06608-2409
US

IV. Provider business mailing address

471 BARNUM AVE
BRIDGEPORT CT
06608-2409
US

V. Phone/Fax

Practice location:
  • Phone: 203-576-3885
  • Fax: 203-332-0376
Mailing address:
  • Phone: 203-576-3885
  • Fax: 203-332-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number00073
License Number StateCT

VIII. Authorized Official

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