Healthcare Provider Details

I. General information

NPI: 1205756541
Provider Name (Legal Business Name): CT ORTHO IONM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 WHITNEY AVE
HAMDEN CT
06518-3209
US

IV. Provider business mailing address

2408 WHITNEY AVE
HAMDEN CT
06518-3209
US

V. Phone/Fax

Practice location:
  • Phone: 203-407-3500
  • Fax:
Mailing address:
  • Phone: 203-407-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN D BADER
Title or Position: CEO
Credential:
Phone: 203-407-3577