Provider Demographics
NPI:1619136579
Name:ADVANCED CENTER FOR FOOT MEDICINE AND SURGERY LLC
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR FOOT MEDICINE AND SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BIANCHINI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-791-0466
Mailing Address - Street 1:57 NORTH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5660
Mailing Address - Country:US
Mailing Address - Phone:203-791-0466
Mailing Address - Fax:
Practice Address - Street 1:57 NORTH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5660
Practice Address - Country:US
Practice Address - Phone:203-791-0466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000580213ES0131X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty