# EASTERN SPORTS MEDICINE AND SPINE ASSOCIATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679950950
- **Authorized official:** CHERYL FLANAGAN (CREDENTIALER)
- **Authorized official phone:** (860) 282-4133

## Contact information

- **Practice address:** 2800 TAMARACK AVE, SUITE 104, SOUTH WINDSOR, CT 06074
- **Practice address phone:** (860) 648-0814
- **Mailing address:** 99 EAST RIVER DR, 5TH FLOOR, EAST HARTFORD, CT 06108-7301
- **Mailing address phone:** (860) 282-4133
- **Mailing address fax:** (860) 289-0746

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 038984 | CT | Yes |

## Other

- **Enumeration date:** 05/06/2015
- **Last updated:** 05/06/2015