| NPI | 1881785012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEAL BRADLEY ZOMBACK Member 203-562-7688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 466) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: CT 466) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CT 762) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CT 000466) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2008-09-12 |