| NPI | 1073396453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEONA DEICKE Credentialing Specialist 203-641-9529 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery |
| 213E00000X Podiatrist | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2023-08-17 |