Organization
PRISM SPORTS MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL NISSEN MD (OWNER)
(860) 282-4128
Entity
Organization
Contact information
Practice address
31 SEYMOUR ST STE 204, HARTFORD, CT 06106-5505
(860) 421-3233
Mailing address
31 PINNACLE RIDGE RD, FARMINGTON, CT 06032-3041
(860) 421-3233
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000
—
CT
Enumeration date
04/08/2020
Last updated
11/19/2025
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