Provider Demographics
NPI:1598827529
Name:CENTERAL NEW ENGLAND FOOTCARE, INC.
Entity Type:Organization
Organization Name:CENTERAL NEW ENGLAND FOOTCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:GENOVESE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-632-5722
Mailing Address - Street 1:52 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1608
Mailing Address - Country:US
Mailing Address - Phone:978-632-5722
Mailing Address - Fax:
Practice Address - Street 1:52 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1608
Practice Address - Country:US
Practice Address - Phone:978-632-5722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1625213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty