Provider Demographics
NPI:1750308672
Name:WEST CONNECTICUT PODIATRY, LLC
Entity Type:Organization
Organization Name:WEST CONNECTICUT PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSNAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-730-0009
Mailing Address - Street 1:235 MAIN ST
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6673
Mailing Address - Country:US
Mailing Address - Phone:203-730-0009
Mailing Address - Fax:203-743-0455
Practice Address - Street 1:235 MAIN ST
Practice Address - Street 2:SUITE #105
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6673
Practice Address - Country:US
Practice Address - Phone:203-730-0009
Practice Address - Fax:203-743-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000765213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008039797Medicaid