Healthcare Provider Details

I. General information

NPI: 1841319019
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF HARTFORD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HART ST
NEW BRITAIN CT
06052-1743
US

IV. Provider business mailing address

270 FARMINGTON AVE SUITE 102
FARMINGTON CT
06032-1909
US

V. Phone/Fax

Practice location:
  • Phone: 860-223-8553
  • Fax: 860-223-7273
Mailing address:
  • Phone: 860-549-8276
  • Fax: 860-674-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001539
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number030915
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19436
License Number StateCT

VIII. Authorized Official

Name: DAVID J MUDANO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 860-549-8276