Healthcare Provider Details

I. General information

NPI: 1215313614
Provider Name (Legal Business Name): THE CENTER FOR FOOT AND ANKLE SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 N MAIN ST
WALLINGFORD CT
06492-3721
US

IV. Provider business mailing address

187 N MAIN ST
WALLINGFORD CT
06492-3721
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-4814
  • Fax: 203-949-4741
Mailing address:
  • Phone: 203-265-4814
  • Fax: 203-949-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000893
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number000893
License Number StateCT

VIII. Authorized Official

Name: DR. CHRISTOPHER MICHAEL YARDAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 203-265-4814