Provider Demographics
NPI:1689873887
Name:EASTERN CONNECTICUT FOOT SPECIALISTS, P. C.
Entity Type:Organization
Organization Name:EASTERN CONNECTICUT FOOT SPECIALISTS, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:TARKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-887-3538
Mailing Address - Street 1:11 WAWECUS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2121
Mailing Address - Country:US
Mailing Address - Phone:860-887-3538
Mailing Address - Fax:860-887-1394
Practice Address - Street 1:11 WAWECUS ST STE 2
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2121
Practice Address - Country:US
Practice Address - Phone:860-887-3538
Practice Address - Fax:860-887-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000570213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCE0564OtherRAIL ROAD MEDICARE GROUP PTAN
CTC01701Medicare PIN
CTT87069Medicare UPIN
CT1306320001Medicare NSC