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General NPI Number Information
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NPI Number | 1811942675
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Entity Type | Organization
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Legal Business Name | THE ORTHOPAEDIC GROUP, LLC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 199 WHITNEY AVE
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City | NEW HAVEN
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State | CT
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Zip | 06511-3786
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Country | US
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Telephone | 203-865-6784
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Fax | 203-865-6788
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Provider Business Mailing Address
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Address Line | 199 WHITNEY AVE
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City | NEW HAVEN
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State | CT
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Zip | 06511-3786
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Country | US
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Telephone | 203-865-6784
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Fax | 203-865-6788
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MICHAEL DECHELLO
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Credential |
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Telephone | 203-865-6784
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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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