Provider Demographics
NPI:1093894263
Name:FAMILY FOOTCARE, PC
Entity Type:Organization
Organization Name:FAMILY FOOTCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-723-7884
Mailing Address - Street 1:1183 NEW HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-5033
Mailing Address - Country:US
Mailing Address - Phone:203-723-7884
Mailing Address - Fax:203-723-2946
Practice Address - Street 1:52 FEDERAL RD STE 1A
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6162
Practice Address - Country:US
Practice Address - Phone:203-792-3668
Practice Address - Fax:203-796-7478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CT000461332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004094554Medicaid
CT0520630003Medicare NSC
CTC00823Medicare PIN