Healthcare Provider Details

I. General information

NPI: 1780736728
Provider Name (Legal Business Name): STAMFORD PODIATRY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 SUMMER ST STE 202
STAMFORD CT
06905-5510
US

IV. Provider business mailing address

1234 SUMMER ST STE 202
STAMFORD CT
06905-5510
US

V. Phone/Fax

Practice location:
  • Phone: 203-323-1711
  • Fax: 203-323-4649
Mailing address:
  • Phone: 203-323-1711
  • Fax: 203-323-4649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: KATHY T GIORDANO
Title or Position: MANAGER
Credential:
Phone: 203-323-1171