Provider Demographics
NPI:1407047954
Name:FAIRFIELD PODIATRY ASSOCIATES LLC
Entity Type:Organization
Organization Name:FAIRFIELD PODIATRY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:IORIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM MPH
Authorized Official - Phone:203-372-7445
Mailing Address - Street 1:2321 BLACK ROCK TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825
Mailing Address - Country:US
Mailing Address - Phone:203-372-7445
Mailing Address - Fax:203-372-0506
Practice Address - Street 1:2321 BLACK ROCK TURNPIKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3220
Practice Address - Country:US
Practice Address - Phone:203-372-7445
Practice Address - Fax:203-372-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00261Medicare PIN
CT0667670001Medicare NSC