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General NPI Number Information
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NPI Number | 1467638817
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Entity Type | Organization
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Legal Business Name | FAMILY FOOT CARE AND SURGERY, LLC
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 247 BROAD ST STE 3
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City | MILFORD
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State | CT
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Zip | 06460-3273
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Country | US
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Telephone | 203-876-7736
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Fax |
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Provider Business Mailing Address
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Address Line | 247 BROAD ST STE 3
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City | MILFORD
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State | CT
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Zip | 06460-3273
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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 | ADMIN
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Name | ELIZABETH RUDY
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Credential |
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Telephone | 850-353-2396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 000509
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 000509
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License Number State | CT
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