Provider Demographics
NPI:1669656534
Name:RECONSTRUCTIVE FOOT SURGEON LLC
Entity Type:Organization
Organization Name:RECONSTRUCTIVE FOOT SURGEON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAMADAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-701-0252
Mailing Address - Street 1:234 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3278
Mailing Address - Country:US
Mailing Address - Phone:203-701-0252
Mailing Address - Fax:203-876-0937
Practice Address - Street 1:234 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3278
Practice Address - Country:US
Practice Address - Phone:203-701-0252
Practice Address - Fax:203-876-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4530810001Medicare NSC