Basic Information
| Provider Information | |||||||||
| NPI: | 1750652285 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAMDEN INJURY REHABILITATION CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4138 | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065140138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032887300 | ||||||||
| FaxNumber: | 2036724475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 DIXWELL AVE | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065143147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032887300 | ||||||||
| FaxNumber: | 2036724475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2012 | ||||||||
| LastUpdateDate: | 01/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | BARONE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2032887300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 000627 | CT | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.