Healthcare Provider Details

I. General information

NPI: 1881785012
Provider Name (Legal Business Name): COMPLETE FOOT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 TEMPLE ST
NEW HAVEN CT
06513-2716
US

IV. Provider business mailing address

60 TEMPLE ST
NEW HAVEN CT
06510-2716
US

V. Phone/Fax

Practice location:
  • Phone: 203-562-7688
  • Fax: 203-624-3131
Mailing address:
  • Phone: 203-562-7688
  • Fax: 203-624-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number466
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number466
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number762
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number000466
License Number StateCT

VIII. Authorized Official

Name: DR. NEAL BRADLEY ZOMBACK
Title or Position: MEMBER
Credential: D.P.M.
Phone: 203-562-7688