| NPI | 1811955057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH E WATERMAN Director Officer 860-638-4671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000735) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CT 000735) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2016-03-22 |