Healthcare Provider Details

I. General information

NPI: 1760690572
Provider Name (Legal Business Name): AFFILIATED FOOT SURGEONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 BLAKE ST
NEW HAVEN CT
06515-1287
US

IV. Provider business mailing address

508 BLAKE ST
NEW HAVEN CT
06515-1287
US

V. Phone/Fax

Practice location:
  • Phone: 203-397-0624
  • Fax: 203-397-0372
Mailing address:
  • Phone: 203-397-0624
  • Fax: 203-397-0372

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number00581
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER ANDREW BLUME
Title or Position: PRESIDENT
Credential: DPM
Phone: 203-397-0624