Provider Demographics
NPI:1114174760
Name:COMPLETE FOOT CARE LLC
Entity Type:Organization
Organization Name:COMPLETE FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:ZOMBACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-562-7688
Mailing Address - Street 1:140 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8427
Mailing Address - Country:US
Mailing Address - Phone:203-562-7688
Mailing Address - Fax:203-624-3131
Practice Address - Street 1:140 CLARK ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-8427
Practice Address - Country:US
Practice Address - Phone:203-877-6501
Practice Address - Fax:203-876-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT466213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5789460002Medicare NSC