Provider Demographics
NPI:1952428518
Name:FAMILY FOOT CARE CENTER, LLC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-289-4500
Mailing Address - Street 1:11 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3102
Mailing Address - Country:US
Mailing Address - Phone:860-289-4500
Mailing Address - Fax:860-528-5289
Practice Address - Street 1:11 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3102
Practice Address - Country:US
Practice Address - Phone:860-289-4500
Practice Address - Fax:860-528-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004142915Medicaid
CTD300008776Medicare UPIN
CT004142915Medicaid