Provider Demographics
NPI:1235281288
Name:BLOOMFIELD FOOT SPECIALISTS,LLC
Entity Type:Organization
Organization Name:BLOOMFIELD FOOT SPECIALISTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATIRST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-243-1951
Mailing Address - Street 1:705 BLOOMFIELD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2480
Mailing Address - Country:US
Mailing Address - Phone:860-243-2951
Mailing Address - Fax:860-243-5790
Practice Address - Street 1:705 BLOOMFIELD AVE STE 201
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2480
Practice Address - Country:US
Practice Address - Phone:860-243-2951
Practice Address - Fax:860-243-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213ES0103X
CT000530332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1162763OtherUNITED HEALTH PROVIDER ID
CT2V4184OtherHEALTH NET PROVIDER ID
CT004235653Medicaid
CT0170716OtherCIGNA PROVIDER ID
CT1093710972OtherNPI
CT030000530CT04OtherANTHEM PROVIDER ID
CT1235281288OtherNPI
CT3204678OtherAETNA PROVIDER ID
CTPL0161OtherMEDIBLUE PROVIDER ID
CT748411OtherCONNECTICARE PROVIDER ID
CTHAS386OtherOXFORD PROVIDER ID
CT298258OtherWELLCARE PROVIDER ID
CT480000912OtherMEDICARE PROVIDER ID
CT3204678OtherAETNA PROVIDER ID
CT4829640001Medicare NSC