Healthcare Provider Details

I. General information

NPI: 1053335083
Provider Name (Legal Business Name): SANJAY PATEL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
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: 203-876-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number000509
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000509
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000509
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000509
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: