Provider Demographics
NPI:1659569051
Name:FOOT AND ANKLE SPECIALISTS OF CT,P.C.
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF CT,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHARNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-924-4747
Mailing Address - Street 1:9 COTS ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3866
Mailing Address - Country:US
Mailing Address - Phone:203-924-4747
Mailing Address - Fax:
Practice Address - Street 1:9 COTS ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3866
Practice Address - Country:US
Practice Address - Phone:203-924-4747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00184213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004006565Medicaid
CTC02237Medicare PIN
480000224Medicare PIN