Healthcare Provider Details

I. General information

NPI: 1710988985
Provider Name (Legal Business Name): AFFILIATED PODIATRISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2A TOPSTONE DR
BETHEL CT
06801-2624
US

IV. Provider business mailing address

2A TOPSTONE DR
BETHEL CT
06801-2624
US

V. Phone/Fax

Practice location:
  • Phone: 203-942-9141
  • Fax:
Mailing address:
  • Phone: 203-942-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000749
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number000749
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number000749
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number000749
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number000749
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number000749
License Number StateCT
# 7
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000749
License Number StateCT

VIII. Authorized Official

Name: DR. SAMIR F ZAKY
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 203-942-9141