Provider Demographics
NPI:1811154511
Name:PODIATRY GROUP OF NEW HAVEN, PC
Entity type:Organization
Organization Name:PODIATRY GROUP OF NEW HAVEN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:K
Authorized Official - Last Name:PARAGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-624-1516
Mailing Address - Street 1:200 ORCHARD ST
Mailing Address - Street 2:STE 102
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5363
Mailing Address - Country:US
Mailing Address - Phone:203-624-1516
Mailing Address - Fax:203-624-8320
Practice Address - Street 1:200 ORCHARD ST
Practice Address - Street 2:STE 102
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5363
Practice Address - Country:US
Practice Address - Phone:203-624-1516
Practice Address - Fax:203-624-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000760213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4062451Medicaid
CTCA0256OtherRAILROAD MEDICARE
CT480000332Medicare PIN
CTCA0256OtherRAILROAD MEDICARE