Provider Demographics
NPI:1902000276
Name:CONNECTICUT NEUROSURGICAL SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:CONNECTICUT NEUROSURGICAL SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:LIPOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-384-4500
Mailing Address - Street 1:267 GRANT STREET
Mailing Address - Street 2:SCHINE 8
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2805
Mailing Address - Country:US
Mailing Address - Phone:203-384-4500
Mailing Address - Fax:203-384-3812
Practice Address - Street 1:267 GRANT STREET
Practice Address - Street 2:SCHINE 8
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2805
Practice Address - Country:US
Practice Address - Phone:203-384-4500
Practice Address - Fax:203-384-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026386207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001359018Medicaid
CT001263862Medicaid
CT140000144Medicare ID - Type Unspecified
G43145Medicare UPIN
CT001359018Medicaid
B38483Medicare UPIN