Healthcare Provider Details

I. General information

NPI: 1467638817
Provider Name (Legal Business Name): FAMILY FOOT CARE AND SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 BROAD ST STE 3
MILFORD CT
06460-3273
US

IV. Provider business mailing address

247 BROAD ST STE 3
MILFORD CT
06460-3273
US

V. Phone/Fax

Practice location:
  • Phone: 203-876-7736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000509
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number000509
License Number StateCT

VIII. Authorized Official

Name: ELIZABETH RUDY
Title or Position: ADMIN
Credential:
Phone: 850-353-2396