Provider Demographics
NPI:1710976477
Name:LEE M. HURNEY D.P.M. PC
Entity Type:Organization
Organization Name:LEE M. HURNEY D.P.M. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:HURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-481-8969
Mailing Address - Street 1:125 MONTOWESE ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3809
Mailing Address - Country:US
Mailing Address - Phone:203-481-8969
Mailing Address - Fax:203-483-8106
Practice Address - Street 1:125 MONTOWESE ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3809
Practice Address - Country:US
Practice Address - Phone:203-481-8969
Practice Address - Fax:203-483-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000087213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0627370001Medicare NSC