Provider Demographics
NPI:1295920908
Name:PREFERRED FOOTCARE LLC
Entity type:Organization
Organization Name:PREFERRED FOOTCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-975-9600
Mailing Address - Street 1:1100 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5305
Mailing Address - Country:US
Mailing Address - Phone:203-975-9600
Mailing Address - Fax:203-323-8430
Practice Address - Street 1:1100 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5305
Practice Address - Country:US
Practice Address - Phone:203-975-9600
Practice Address - Fax:203-323-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X, 332B00000X
CT00693174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004196657Medicaid
U75202Medicare UPIN
CTU75202Medicare UPIN
CT4365450001Medicare NSC
480000919Medicare PIN
CT480000919Medicare PIN
CT004196657Medicaid