1902015662 NPI number — FOOT AND ANKLE SPECIALISTS OF CT,P.C.

Table of content: ERYN LOVE SCHICK (NPI 1063130961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902015662 NPI number — FOOT AND ANKLE SPECIALISTS OF CT,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT AND ANKLE SPECIALISTS OF CT,P.C.
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:
6
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:
1902015662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 COTS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06484-3866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-924-4747
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 COTS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06484-3866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-924-4747
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHARNOFF
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-924-4747

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  000184 , 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: 5020099 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004006565 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 768326 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 030000184CT01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 41608 . This is a "AETNA HEALTH PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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