Healthcare Provider Details

I. General information

NPI: 1588983415
Provider Name (Legal Business Name): INTERVENTIONAL SPINE & SPORTS MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 STRAITS TPKE TURNPIKE OFFICE PARK
MIDDLEBURY CT
06762-1835
US

IV. Provider business mailing address

1579 STRAITS TPKE TURNPIKE OFFICE PARK
MIDDLEBURY CT
06762-1835
US

V. Phone/Fax

Practice location:
  • Phone: 203-598-7246
  • Fax: 203-598-0200
Mailing address:
  • Phone: 203-598-7246
  • Fax: 203-598-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number040593
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number040593
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. BHAVESH R PATEL
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 203-645-8859