| NPI | 1982961397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAPHETH OGAMBA MONGARE Podiatrist 203-606-2694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CT 881) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CT 881) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CT 881) | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2015-01-16 |