Provider Demographics
NPI:1992109284
Name:PAVILION HAND SURGEONS, INC
Entity type:Organization
Organization Name:PAVILION HAND SURGEONS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WINT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-733-2204
Mailing Address - Street 1:3550 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1078
Mailing Address - Country:US
Mailing Address - Phone:413-733-2204
Mailing Address - Fax:413-734-0587
Practice Address - Street 1:115 ELM ST STE 208
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3735
Practice Address - Country:US
Practice Address - Phone:860-698-6966
Practice Address - Fax:413-734-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1871655662OtherNPI
CTD100172348OtherMEDICARE PTAN
MAM11285OtherMEDICARE PTAN