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General NPI Number Information
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NPI Number | 1104000330
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Entity Type | Organization
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Legal Business Name | PATRICK FETTINGER, DPM
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 88 STATE ROUTE 37 FIELDSTONE PLAZA
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City | NEW FAIRFIELD
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State | CT
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Zip | 06812-5036
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Country | US
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Telephone | 203-746-9660
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Fax | 203-746-4186
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Provider Business Mailing Address
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Address Line | PO BOX 8236
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City | NEW FAIRFIELD
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State | CT
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Zip | 06812
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Country | US
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Telephone | 203-746-9660
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Fax | 203-746-4186
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK FETTINGER
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Credential | DPM
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Telephone | 203-746-9660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 625
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 00625
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License Number State | CT
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