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General NPI Number Information
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NPI Number | 1396957825
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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 | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 520 OLD SAYBROOK ROAD SUITE 100
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-344-0118
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Fax | 860-344-0461
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Provider Business Mailing Address
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Address Line | 330 ORCHARD STREET SUITE 316
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City | NEW HAVEN
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State | CT
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Zip | 06511-4430
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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 | MD
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Name | PATRICK TOMAK
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 037965
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License Number State | CT
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