Healthcare Provider Details

I. General information

NPI: 1093997892
Provider Name (Legal Business Name): CONNECTICUT FOOT CARE CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 FARMINGTON AVE
KENSINGTON CT
06037-2218
US

IV. Provider business mailing address

PO BOX 37
ROCKY HILL CT
06067-0037
US

V. Phone/Fax

Practice location:
  • Phone: 860-828-3455
  • Fax: 860-828-9557
Mailing address:
  • Phone: 860-563-1200
  • Fax: 860-563-2665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY STEVEN KAHN
Title or Position: MANAGING PARTNER
Credential: D.P.M.
Phone: 860-563-1200