MEDICARE: PHYSICAL MEDICINE & REHABILITATION OF HARTFORD LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	035179	CT
2	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician	035179	CT
3	261QR0400X	Rehabilitation Clinic/Center	035179	CT
4	2081P0010X	Pediatric Rehabilitation Medicine Physician	035179	CT
5	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346246931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL MEDICINE & REHABILITATION OF HARTFORD LLC

Provider Business Mailing Address
First Line	:	35 JOLLEY DR
Second Line	:	STE 101
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3062
Country	:	US
Telephone Number	:	860-243-3434
Fax Number	:	860-243-0208

Provider Business Practice Location Address
First Line	:	35 JOLLEY DR
Second Line	:	STE 101
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002
Country	:	US
Telephone Number	:	860-243-3434
Fax Number	:	860-243-0208

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID A FEINGOLD
Credential	:	MD
Telephone Number	:	860-243-3434

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	05/15/2018

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