Provider Demographics
NPI:1063588648
Name:ORTHOPEDIC ASSOCIATES OF HARTFORD,PC
Entity type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF HARTFORD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUDANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-549-8279
Mailing Address - Street 1:270 FARMINGTON AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1909
Mailing Address - Country:US
Mailing Address - Phone:860-549-3210
Mailing Address - Fax:860-674-8084
Practice Address - Street 1:428 HARTFORD TPKE
Practice Address - Street 2:SUITE 201
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4841
Practice Address - Country:US
Practice Address - Phone:860-549-3210
Practice Address - Fax:860-674-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty