Provider Demographics
NPI:1174783690
Name:ORTHOPEDIC ASSOCIATES OF WINDHAM COUNTY
Entity type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF WINDHAM COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STONGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:860-963-2133
Mailing Address - Street 1:39 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1957
Mailing Address - Country:US
Mailing Address - Phone:860-963-2133
Mailing Address - Fax:860-963-8955
Practice Address - Street 1:39 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1957
Practice Address - Country:US
Practice Address - Phone:860-963-2133
Practice Address - Fax:860-963-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01454Medicare PIN