Provider Demographics
NPI:1962433904
Name:SURGICAL ASSOCIATES OF MILFORD PC
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF MILFORD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-876-4231
Mailing Address - Street 1:831 BOSTON POST RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3536
Mailing Address - Country:US
Mailing Address - Phone:203-878-6377
Mailing Address - Fax:203-876-0652
Practice Address - Street 1:831 BOSTON POST RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3536
Practice Address - Country:US
Practice Address - Phone:203-878-6377
Practice Address - Fax:203-876-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004000618Medicaid
CT004000618Medicaid