Healthcare Provider Details

I. General information

NPI: 1275929291
Provider Name (Legal Business Name): CT FAMILY FOOT CARE AND SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 WHITNEY AVE. 3RD FLOOR
HAMDEN CT
06517
US

IV. Provider business mailing address

1952 WHITNEY AVE. 3RD FLOOR
HAMDEN CT
06517
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-0129
  • Fax: 203-288-1858
Mailing address:
  • Phone: 203-288-0129
  • Fax: 203-288-1858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000760
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number000760
License Number StateCT

VIII. Authorized Official

Name: DR. LORI K PARAGAS
Title or Position: OWNER
Credential: DPM
Phone: 203-288-0129