| NPI | 1851643258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK BANCROFT VYE VP Administration 860-972-7858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 213E00000X Podiatrist |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2019-07-16 |