Provider Demographics
NPI:1306054309
Name:ORTHOPEDIC ASSOCIATES OF MIDDLETOWN, PC
Entity type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF MIDDLETOWN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:860-704-6037
Mailing Address - Street 1:512 SAYBROOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4788
Mailing Address - Country:US
Mailing Address - Phone:860-347-7636
Mailing Address - Fax:860-894-1802
Practice Address - Street 1:512 SAYBROOK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4788
Practice Address - Country:US
Practice Address - Phone:860-347-7636
Practice Address - Fax:860-894-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X, 207XX0004X, 332B00000X, 213ES0131X, 207XX0005X, 213ES0103X, 2081P2900X, 207XS0106X, 207X00000X
CT043826208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004186260Medicaid
CT004186260Medicaid
CTC02315Medicare Oscar/Certification