Healthcare Provider Details

I. General information

NPI: 1558313767
Provider Name (Legal Business Name): ORTHOPAEDIC SPECIALTY GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BLACK ROCK TPKE
FAIRFIELD CT
06825-5508
US

IV. Provider business mailing address

305 BLACK ROCK TPKE
FAIRFIELD CT
06825-5508
US

V. Phone/Fax

Practice location:
  • Phone: 203-337-2600
  • Fax: 203-337-2611
Mailing address:
  • Phone: 203-337-2600
  • Fax: 203-372-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DANTE BRITTIS
Title or Position: MANAGING EMPLOYEE
Credential: MD
Phone: 203-337-2600