Healthcare Provider Details

I. General information

NPI: 1104000330
Provider Name (Legal Business Name): PATRICK FETTINGER, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 STATE ROUTE 37 FIELDSTONE PLAZA
NEW FAIRFIELD CT
06812-5036
US

IV. Provider business mailing address

PO BOX 8236
NEW FAIRFIELD CT
06812
US

V. Phone/Fax

Practice location:
  • Phone: 203-746-9660
  • Fax: 203-746-4186
Mailing address:
  • Phone: 203-746-9660
  • Fax: 203-746-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number625
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number00625
License Number StateCT

VIII. Authorized Official

Name: DR. PATRICK FETTINGER
Title or Position: OWNER
Credential: DPM
Phone: 203-746-9660