MEDICARE: CONNECTICUT NEUROSURGERY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	207T00000X	Neurological Surgery Physician
3	208100000X	Physical Medicine & Rehabilitation Physician
4	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1093805079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTICUT NEUROSURGERY PC

Provider Business Mailing Address
First Line	:	330 ORCHARD ST
Second Line	:	SUITE 316
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-4417
Country	:	US
Telephone Number	:	203-781-3400
Fax Number	:	203-781-3414

Provider Business Practice Location Address
First Line	:	1 BRADLEY RD
Second Line	:	SUITE 501
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2285
Country	:	US
Telephone Number	:	203-389-2278
Fax Number	:	203-389-2861

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARY M BLOOMGARDEN
Credential	:	MD
Telephone Number	:	203-781-3400

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	09/11/2025

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