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General NPI Number Information
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NPI Number | 1134398415
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Entity Type | Organization
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Legal Business Name | STAMFORD FOOT CENTER, LLC
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 1023 HOPE ST STE 4
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City | STAMFORD
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State | CT
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Zip | 06907-2122
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Country | US
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Telephone | 203-358-9358
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Fax | 203-358-9348
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Provider Business Mailing Address
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Address Line | 1023 HOPE ST STE 4
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City | STAMFORD
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State | CT
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Zip | 06907-2122
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Country | US
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Telephone | 203-358-9358
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Fax | 203-358-9348
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Authorized Official
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Title or Position | SELF
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Name | DR. MARY D REILLY
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Credential | DPM
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Telephone | 203-358-9358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000593
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License Number State | CT
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