Provider Demographics
NPI:1174784797
Name:APPLEGATE ORTHOPEDIC SPINE CENTER PC
Entity type:Organization
Organization Name:APPLEGATE ORTHOPEDIC SPINE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-391-8068
Mailing Address - Street 1:5 PEQUOT PARK RD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-2856
Mailing Address - Country:US
Mailing Address - Phone:860-391-8068
Mailing Address - Fax:
Practice Address - Street 1:5 PEQUOT PARK RD
Practice Address - Street 2:SUITE 201A
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-2856
Practice Address - Country:US
Practice Address - Phone:860-391-8068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044333207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT044333OtherCT LISENSE
CT6171670002Medicare NSC
CTD100000023Medicare PIN
CTI54896Medicare UPIN