Healthcare Provider Details

I. General information

NPI: 1043488422
Provider Name (Legal Business Name): AYMAN MAURICE LATIF DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AYMAN MAURICE LATIF DPM

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 SAYBROOK RD
MIDDLETOWN CT
06457-4743
US

IV. Provider business mailing address

535 SAYBROOK RD
MIDDLETOWN CT
06457-4743
US

V. Phone/Fax

Practice location:
  • Phone: 860-346-5226
  • Fax: 860-347-6280
Mailing address:
  • Phone: 860-346-5226
  • Fax: 860-347-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000839
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00294100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: