=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992871875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTIMUS HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2006
-----------------------------------------------------
Last Update Date | 08/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 471 BARNUM AVE
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06608-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-576-3885
-----------------------------------------------------
Fax | 203-332-0376
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 471 BARNUM AVE
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06608-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-576-3885
-----------------------------------------------------
Fax | 203-332-0376
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | LUDWIG SPINELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-696-3260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 00073
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------