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General NPI Number Information
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NPI Number | 1093805079
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Entity Type | Organization
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Legal Business Name | CONNECTICUT NEUROSURGERY PC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1 BRADLEY RD SUITE 501
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2285
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Country | US
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Telephone | 203-389-2278
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Fax | 203-389-2861
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Provider Business Mailing Address
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Address Line | 330 ORCHARD ST SUITE 316
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City | NEW HAVEN
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State | CT
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Zip | 06511-4417
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Country | US
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Telephone | 203-781-3400
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Fax | 203-781-3414
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY M BLOOMGARDEN
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Credential | MD
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Telephone | 203-781-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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