Healthcare Provider Details

I. General information

NPI: 1699850289
Provider Name (Legal Business Name): DRS KIERSTEIN & DIFRANCESCA DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 PARKWAY S SUITE 302
WATERFORD CT
06385-1234
US

IV. Provider business mailing address

196 PARKWAY S SUITE 304
WATERFORD CT
06385-1234
US

V. Phone/Fax

Practice location:
  • Phone: 860-447-1488
  • Fax: 860-447-1489
Mailing address:
  • Phone: 860-442-7027
  • Fax: 860-444-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JEFFEREY M KIERSTEIN
Title or Position: PHYSICIAN / OWNER
Credential: DPM
Phone: 860-447-1488