Provider Demographics
NPI:1245774942
Name:FAMILY FOOT & ANKLE SPECIALISTS LLC
Entity Type:Organization
Organization Name:FAMILY FOOT & ANKLE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DENISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-969-4788
Mailing Address - Street 1:2409 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5324
Mailing Address - Country:US
Mailing Address - Phone:203-334-6955
Mailing Address - Fax:203-334-2851
Practice Address - Street 1:2409 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5324
Practice Address - Country:US
Practice Address - Phone:203-334-6955
Practice Address - Fax:203-334-2851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty