Orthopaedic Specialty Group, P.C.
Organization Active NPI Diagnostic Radiology Physician · Fairfield, CT
NPI 1114923893 · NPPES record last updated Dec 14, 2018
Key facts
- NPI
- 1114923893
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 016805 (CT)
- Legal business name
- ORTHOPAEDIC SPECIALTY GROUP, P.C.
- Practice address
- 305 Black Rock Tpke
Fairfield, CT 06825 - Phone
- (203) 337-2600
- NPI assigned
- Jun 27, 2005
- Organization subpart
- No
Authorized official
- Name
- Judith Ortiz
- Title
- Credentialing Coordinator
- Phone
- (203) 538-5233
Other NPIs on the same Medicare enrollment 1
Practitioners 62
-
Paul A. Aiello, M.D.
-
John Awad, MD
-
Dante A Brittis, MD
-
Marcus Conti, MD
-
Melissa Ann Davis, M.D.
-
Susan W Marlatt, M.D.
-
Jack Anthony Porrino Jr., M.D.
-
Gordon K Sze, MD
-
Ajay Malhotra, M.D.
-
Rizwan Ahmad, MD
-
Lori Ann Algar, MS, OTRL
-
Nicholas G. Anagnost, PA-C
-
Cindy Sue Anderson, PA-C
-
Sharon Patricia Andruskiwec, PT CHT
-
Henry A Backe, MD
-
Roberto Luis Balado, PA-C
-
Michael J. Brennan, M.D.
-
Brett M Carr, DC
-
Skylar R De Vito, PA-C
-
Laura M Delladonna, RPT
-
Kathy E Delucia, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050428000802 | CT | Part B Supplier - Clinic/Group Practice | 8820037898 |
Receives reassigned benefits from 97 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Monroe, CT; Shelton, CT; Fairfield, CT; Milford, CT; Bridgeport, CT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | 016805 | CT | Yes |
Addresses
Primary practice location
305 Black Rock Tpke
Fairfield, CT 06825
Mailing address
PO Box 6128
Bridgeport, CT 06606-0128
Phone (203) 538-5233
Other practice location 1
305 Black Rock Tpke
Fairfield, CT 06825
Phone (203) 337-2600 ext. 1126
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004107894 | Medicaid | CT |
Other names
- Robert D. Russo, M.D. & Associates Radiology, P.C.
Other providers in Fairfield, CT
- Optimal Healing Center of Connecticut
- Kelly E Orsino
- Adrian Ortega
- Ortho New England, LLC
- Orthoconnecticut, PLLC
- Orthopaedic Specialty Group, P.C.
- Brianna Iraida Ortiz
- Allison Cotter Osipow
- Brendan Osler
- Colleen Marie Osorio Hernandez
All providers in Fairfield, CT · Diagnostic Radiology Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.