Provider Demographics
NPI:1760690572
Name:AFFILIATED FOOT SURGEONS PC
Entity Type:Organization
Organization Name:AFFILIATED FOOT SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-397-0624
Mailing Address - Street 1:508 BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1287
Mailing Address - Country:US
Mailing Address - Phone:203-397-0624
Mailing Address - Fax:203-397-0372
Practice Address - Street 1:508 BLAKE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1287
Practice Address - Country:US
Practice Address - Phone:203-397-0624
Practice Address - Fax:203-397-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213ES0103X, 335E00000X
CT00581332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004128808Medicaid
CT0639830001Medicare NSC
CT004128808Medicaid