Healthcare Provider Details

I. General information

NPI: 1619136579
Provider Name (Legal Business Name): ADVANCED CENTER FOR FOOT MEDICINE AND SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 NORTH ST SUITE 108
DANBURY CT
06810-5660
US

IV. Provider business mailing address

57 NORTH ST SUITE 108
DANBURY CT
06810-5660
US

V. Phone/Fax

Practice location:
  • Phone: 203-791-0466
  • Fax:
Mailing address:
  • Phone: 203-791-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000580
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number000580
License Number StateCT

VIII. Authorized Official

Name: DR. JOSEPH J BIANCHINI
Title or Position: PHYSICIAN
Credential: DPM
Phone: 203-791-0466