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General NPI Number Information
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NPI Number | 1437698685
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Entity Type | Organization
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Legal Business Name | CONNECTICUT FOOT CARE CENTERS LLC
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 505 WILLARD AVE BLDG 2-D
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City | NEWINGTON
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State | CT
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Zip | 06111-2650
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Country | US
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Telephone | 860-666-2078
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Fax | 860-665-8247
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Provider Business Mailing Address
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Address Line | PO BOX 37
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City | ROCKY HILL
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State | CT
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Zip | 06067-0037
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Country | US
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Telephone | 860-563-1200
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Fax | 860-563-2665
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. JEFFREY STEVEN KAHN
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Credential | D.P.M.
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Telephone | 860-563-1200
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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 | CT000092
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License Number State | CT
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