Provider Demographics
NPI:1306854864
Name:NEW HAVEN PODIATRY ASSOCIATES LLP
Entity Type:Organization
Organization Name:NEW HAVEN PODIATRY ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:SLOMSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-624-9991
Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-624-9991
Mailing Address - Fax:203-624-6815
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-624-9991
Practice Address - Fax:203-624-6815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004396851Medicaid
CTCM7225OtherRAILROAD MEDICARE
CTC01330Medicare PIN
CT0445720001Medicare NSC