1710988985 NPI number — AFFILIATED PODIATRISTS LLC

Table of content: (NPI 1710988985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710988985 NPI number — AFFILIATED PODIATRISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFILIATED PODIATRISTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710988985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2A TOPSTONE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHEL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06801-2624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-942-9141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2A TOPSTONE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHEL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06801-2624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-942-9141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZAKY
Authorized Official First Name:
SAMIR
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
203-942-9141

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  000749 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213EP1101X , with the licence number: 000749 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213EP0504X , with the licence number: 000749 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ER0200X , with the licence number: 000749 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0000X , with the licence number: 000749 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 000749 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 000749 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9577804 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004216299 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00058892 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2630726 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 030000749CT02 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".