Provider Demographics
NPI:1518227669
Name:ADVANCED FOOTCARE CENTER
Entity Type:Organization
Organization Name:ADVANCED FOOTCARE CENTER
Other - Org Name:CENTER PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-799-3668
Mailing Address - Street 1:109 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3235
Mailing Address - Country:US
Mailing Address - Phone:203-799-3668
Mailing Address - Fax:203-891-0766
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-3003
Practice Address - Country:US
Practice Address - Phone:203-799-3668
Practice Address - Fax:203-891-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty