| NPI | 1235316597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS M DOMANICK Owner 203-377-1777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: CT POO289) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT POO289) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2012-11-07 |