Provider Demographics
NPI:1376967273
Name:STAMFORD PODIATRY GROUP PC
Entity Type:Organization
Organization Name:STAMFORD PODIATRY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:T
Authorized Official - Last Name:GIORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-323-1171
Mailing Address - Street 1:1234 SUMMER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5558
Mailing Address - Country:US
Mailing Address - Phone:203-323-1171
Mailing Address - Fax:203-323-4649
Practice Address - Street 1:1234 SUMMER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5558
Practice Address - Country:US
Practice Address - Phone:203-323-1171
Practice Address - Fax:203-323-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier