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General NPI Number Information
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NPI Number | 1386922151
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Entity Type | Organization
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Legal Business Name | DPMDECKERPRCT, LLC
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Dates
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Enumeration Date | 07/28/2011
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 300 HEBRON AVE SUITE 211
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City | GLASTONBURY
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State | CT
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Zip | 06033-2176
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Country | US
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Telephone | 860-657-3668
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Fax | 860-657-1678
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Provider Business Mailing Address
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Address Line | 196 PARKWAY S SUITE 304
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City | WATERFORD
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State | CT
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Zip | 06385-1234
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Country | US
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Telephone | 860-442-7027
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Fax | 860-437-2236
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Authorized Official
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Title or Position | OWNER/PODIATRIST
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Name | JENNIFER R DECKER
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Credential | DPM
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Telephone | 860-657-3668
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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 | 000853
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License Number State | CT
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