Healthcare Provider Details

I. General information

NPI: 1669656534
Provider Name (Legal Business Name): RECONSTRUCTIVE FOOT SURGEON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 BROAD ST
MILFORD CT
06460-3278
US

IV. Provider business mailing address

234 BROAD ST
MILFORD CT
06460-3278
US

V. Phone/Fax

Practice location:
  • Phone: 203-701-0252
  • Fax: 203-876-0937
Mailing address:
  • Phone: 203-701-0252
  • Fax: 203-876-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. NADIM M RAMADAN
Title or Position: OWNER
Credential: DPM
Phone: 203-701-0252