Provider Demographics
NPI:1164596482
Name:PODIATRY GROUP OF NEW BRITAIN/SOUTHINGTON. P.C.
Entity Type:Organization
Organization Name:PODIATRY GROUP OF NEW BRITAIN/SOUTHINGTON. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:M
Authorized Official - Last Name:VELEAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-621-6828
Mailing Address - Street 1:221 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489
Mailing Address - Country:US
Mailing Address - Phone:860-621-6828
Mailing Address - Fax:860-621-6820
Practice Address - Street 1:221 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-621-6828
Practice Address - Fax:860-621-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000213213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0159439001OtherCIGNA
CT500000213CT01OtherANTHEM BC/BS
CT500000213CT01OtherANTHEM BC/BS
CT480000183Medicare PIN