Healthcare Provider Details

I. General information

NPI: 1225302136
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF MIDDLETOWN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BREWSTER RD LEVEL D
BRISTOL CT
06010-5161
US

IV. Provider business mailing address

512 SAYBROOK RD SUITE 100
MIDDLETOWN CT
06457-4788
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-3040
  • Fax: 860-585-3307
Mailing address:
  • Phone: 860-347-7636
  • Fax: 860-894-1894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRY F REARDON
Title or Position: PHYSICIAN
Credential: MD
Phone: 860-347-7636