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General NPI Number Information
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NPI Number | 1497709885
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR RECONSTRUCTIVE FOOT SURGERY, P.C.
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 1 LIBERTY SQ
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City | NEW BRITAIN
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State | CT
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Zip | 06051-2637
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Country | US
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Telephone | 860-229-2807
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Fax | 860-229-2812
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Provider Business Mailing Address
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Address Line | 1 LIBERTY SQ
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City | NEW BRITAIN
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State | CT
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Zip | 06051-2637
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Country | US
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Telephone | 860-229-2807
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Fax | 860-229-2812
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY P. JOLLY
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Credential | DPM
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Telephone | 860-229-2807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 000090
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License Number State | CT
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