Healthcare Provider Details

I. General information

NPI: 1235286949
Provider Name (Legal Business Name): ORTHOPAEDIC MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 NEW HAVEN AVE
DERBY CT
06418-2534
US

IV. Provider business mailing address

435 NEW HAVEN AVE
DERBY CT
06418-2534
US

V. Phone/Fax

Practice location:
  • Phone: 203-736-0086
  • Fax: 203-736-0097
Mailing address:
  • Phone: 203-736-0086
  • Fax: 203-736-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number038856
License Number StateCT

VIII. Authorized Official

Name: DR. GERARD ABIDOR
Title or Position: PRESIDENT
Credential: D.O.
Phone: 203-736-0086