Provider Demographics
NPI:1689859050
Name:CHRISTOPHER R PAYETTE
Entity Type:Organization
Organization Name:CHRISTOPHER R PAYETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAYETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-774-3668
Mailing Address - Street 1:263 POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1835
Mailing Address - Country:US
Mailing Address - Phone:860-928-3667
Mailing Address - Fax:860-963-9008
Practice Address - Street 1:263 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1835
Practice Address - Country:US
Practice Address - Phone:860-928-3667
Practice Address - Fax:860-963-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000663332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4740590003Medicare NSC