Healthcare Provider Details

I. General information

NPI: 1326239096
Provider Name (Legal Business Name): WINDHAM ORTHOPAEDICS PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HAZARD AVE
ENFIELD CT
06082-4590
US

IV. Provider business mailing address

111 HAZARD AVE
ENFIELD CT
06082-4590
US

V. Phone/Fax

Practice location:
  • Phone: 860-749-8361
  • Fax: 860-749-2004
Mailing address:
  • Phone: 860-749-8361
  • Fax: 860-749-2004

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA MONTANO PAPA
Title or Position: OFFICE MANAGER
Credential:
Phone: 860-749-9325