| NPI | 1306020938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE M RUSSELL Office Manager 203-929-5559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CT 000419) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: CT 000419) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CT 000419) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CT CT000419) | |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2012-04-02 |