Healthcare Provider Details

I. General information

NPI: 1427533959
Provider Name (Legal Business Name): SOMERS ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 OLD RIDGEBURY RD STE 101
DANBURY CT
06810-5123
US

IV. Provider business mailing address

40 OLD RIDGEBURY RD STE 101
DANBURY CT
06810-5123
US

V. Phone/Fax

Practice location:
  • Phone: 203-397-6872
  • Fax: 203-207-0304
Mailing address:
  • Phone: 203-397-6872
  • Fax: 203-207-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOEL BUCHALTER
Title or Position: OWNER
Credential: MD
Phone: 845-230-5121