Provider Demographics
NPI:1497299408
Name:NEW ENGLAND FOOT CARE LLC
Entity Type:Organization
Organization Name:NEW ENGLAND FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-463-7151
Mailing Address - Street 1:351 SALMON BROOK ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-1804
Mailing Address - Country:US
Mailing Address - Phone:860-653-0026
Mailing Address - Fax:
Practice Address - Street 1:351 SALMON BROOK ST
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-1804
Practice Address - Country:US
Practice Address - Phone:860-463-7151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT662213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty