Healthcare Provider Details

I. General information

NPI: 1487980173
Provider Name (Legal Business Name): WILTON FOOTCARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 DANBURY RD 3RD FLOOR
WILTON CT
06897-4405
US

IV. Provider business mailing address

27 DANBURY RD 3RD FLOOR
WILTON CT
06897-4405
US

V. Phone/Fax

Practice location:
  • Phone: 203-761-1230
  • Fax: 203-761-6767
Mailing address:
  • Phone: 203-761-1230
  • Fax: 203-761-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number474
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number474
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL CONNOR
Title or Position: OWNER
Credential: D.P.M.
Phone: 203-761-1230