Provider Demographics
NPI:1528026242
Name:NORTHWEST FOOT SPECIALISTS, L.L.P.
Entity Type:Organization
Organization Name:NORTHWEST FOOT SPECIALISTS, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ONOFRIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-489-4022
Mailing Address - Street 1:52 PECK RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6107
Mailing Address - Country:US
Mailing Address - Phone:860-489-4022
Mailing Address - Fax:860-489-3776
Practice Address - Street 1:52 PECK RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6107
Practice Address - Country:US
Practice Address - Phone:860-489-4022
Practice Address - Fax:860-489-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2008-10-15
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
CT004218906Medicaid
CT004218906Medicaid
CT4401060001Medicare NSC