Healthcare Provider Details

I. General information

NPI: 1235204009
Provider Name (Legal Business Name): NORTHEAST ORTHOPAEDIC & HAND SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WESTWOOD AVE SUITE 300
WATERBURY CT
06708
US

IV. Provider business mailing address

60 WESTWOOD AVE SUITE 300
WATERBURY CT
06708
US

V. Phone/Fax

Practice location:
  • Phone: 203-755-9166
  • Fax: 203-755-5932
Mailing address:
  • Phone: 203-755-9166
  • Fax: 203-755-5932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT P HENDRIKSON
Title or Position: PRESIDENT
Credential: MD
Phone: 203-755-9166