Provider Demographics
NPI:1013198639
Name:PODIATRIC MEDICAL AND COSMETIC CONSULTANTS OF CT,LLC
Entity Type:Organization
Organization Name:PODIATRIC MEDICAL AND COSMETIC CONSULTANTS OF CT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-894-8774
Mailing Address - Street 1:90 GROVE ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4114
Mailing Address - Country:US
Mailing Address - Phone:203-894-8774
Mailing Address - Fax:203-894-8359
Practice Address - Street 1:90 GROVE ST
Practice Address - Street 2:SUITE 211
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4114
Practice Address - Country:US
Practice Address - Phone:203-894-8774
Practice Address - Fax:203-894-8359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000577213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU34505Medicare UPIN