| NPI | 1053395400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS C MCKELL Chief Administrative Officer 860-524-4326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 213E00000X Podiatrist |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2010-08-11 |