Provider Demographics
NPI:1669237764
Name:FORWARD ORTHOPEDIC AND SPINE CENTER LLC
Entity type:Organization
Organization Name:FORWARD ORTHOPEDIC AND SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MORENIKEJI
Authorized Official - Middle Name:
Authorized Official - Last Name:BURAIMOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-281-4340
Mailing Address - Street 1:130 BIRDSEYE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 BIRDSEYE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2444
Practice Address - Country:US
Practice Address - Phone:860-247-3279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty