Healthcare Provider Details

I. General information

NPI: 1225430499
Provider Name (Legal Business Name): ORTHOCONNECTICUT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 KINGS HWY N
WESTPORT CT
06880-2439
US

IV. Provider business mailing address

761 MAIN AVE SUITE 115
NORWALK CT
06851-1080
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-2200
  • Fax: 203-847-1940
Mailing address:
  • Phone: 203-845-2200
  • Fax: 203-847-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD C LYON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 203-845-2200