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General NPI Number Information
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NPI Number | 1104903616
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Entity Type | Organization
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Legal Business Name | DIABETIC FOOTWEAR CENTERS LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 21 BUSINESS PARK DR
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City | BRANFORD
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State | CT
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Zip | 06405-2935
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Country | US
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Telephone | 203-481-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 23 BUSINESS PARK DR
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City | BRANFORD
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State | CT
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Zip | 06405-2925
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JAY RICHELLI
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Credential |
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Telephone | 203-315-5934
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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 |
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License Number State |
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