Provider Demographics
NPI:1750446399
Name:CONNECTICUT FOOT CARE CENTERS LLC
Entity Type:Organization
Organization Name:CONNECTICUT FOOT CARE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-563-1200
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-0037
Mailing Address - Country:US
Mailing Address - Phone:860-563-1200
Mailing Address - Fax:860-563-2665
Practice Address - Street 1:505 WILLARD AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2650
Practice Address - Country:US
Practice Address - Phone:860-666-2078
Practice Address - Fax:860-665-8247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01817OtherMEDICARE GROUP PTAN
CTC01816OtherMEDICARE GROUP PTAN
CT480000637Medicare PIN
CT480000854Medicare PIN
CTC01817OtherMEDICARE GROUP PTAN
CT4997100001Medicare NSC
CT480000636Medicare PIN