Healthcare Provider Details

I. General information

NPI: 1942485917
Provider Name (Legal Business Name): NEW MILFORD PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 KENT ROAD
NEW MILFORD CT
06776-3485
US

IV. Provider business mailing address

131 KENT ROAD
NEW MILFORD CT
06776-3485
US

V. Phone/Fax

Practice location:
  • Phone: 860-354-8616
  • Fax: 860-354-0473
Mailing address:
  • Phone: 860-354-8616
  • Fax: 860-354-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number000676
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000676
License Number StateCT

VIII. Authorized Official

Name: DR. THOMAS G GUGLIELMO
Title or Position: OWNER
Credential: D.P.M.
Phone: 860-354-8616