Healthcare Provider Details

I. General information

NPI: 1558474742
Provider Name (Legal Business Name): MIDDLESEX ORTHOPEDIC SURGEONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 SAYBROOK RD STE 100
MIDDLETOWN CT
06457-4780
US

IV. Provider business mailing address

410 SAYBROOK RD STE 100
MIDDLETOWN CT
06457-4780
US

V. Phone/Fax

Practice location:
  • Phone: 860-685-8940
  • Fax:
Mailing address:
  • Phone: 860-685-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SEAN J O'DONNELL
Title or Position: OFFICER/SECRETARY
Credential: MD
Phone: 860-685-8940