Healthcare Provider Details

I. General information

NPI: 1811292675
Provider Name (Legal Business Name): CONNECTICUT FOOT AND ANKLE ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 AMITY RD SUITE 110
WOODBRIDGE CT
06525-2258
US

IV. Provider business mailing address

245 AMITY RD SUITE 110
WOODBRIDGE CT
06525-2258
US

V. Phone/Fax

Practice location:
  • Phone: 203-936-6677
  • Fax: 203-774-3594
Mailing address:
  • Phone: 203-936-6677
  • Fax: 203-774-3594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000781
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number000781
License Number StateCT

VIII. Authorized Official

Name: DR. JONATHAN KEY
Title or Position: PROVIDER
Credential: DPM
Phone: 203-936-6677