Healthcare Provider Details
I. General information
NPI: 1689803967
Provider Name (Legal Business Name): FARMINGTON VALLEY ORTHOPEDIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/08/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
113 ELM ST
ENFIELD CT
06082-3700
US
IV. Provider business mailing address
34 DALE RD
AVON CT
06001-3659
US
V. Phone/Fax
- Phone: 860-677-0079
- Fax: 860-677-4785
- Phone: 860-677-0079
- Fax: 860-677-4785
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207X00000X |
| Taxonomy | Orthopaedic Surgery Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
STEVEN
BOND
Title or Position: PRESIDENT
Credential: MD
Phone: 860-677-0079