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General NPI Number Information
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NPI Number | 1619861556
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Entity Type | Organization
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Legal Business Name | ORTHO PA SERVICES
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 47 BULKLEY AVE N
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City | WESTPORT
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State | CT
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Zip | 06880-4119
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Country | US
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Telephone | 203-513-3264
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Fax |
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Provider Business Mailing Address
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Address Line | 2 TRAP FALLS RD STE 404
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City | SHELTON
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State | CT
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Zip | 06484-4670
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | SCOTT WALLER
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Credential | MD
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Telephone | 203-513-3264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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