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General NPI Number Information
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NPI Number | 1811154511
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Entity Type | Organization
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Legal Business Name | PODIATRY GROUP OF NEW HAVEN, PC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 200 ORCHARD ST STE 102
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City | NEW HAVEN
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State | CT
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Zip | 06511-5363
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Country | US
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Telephone | 203-624-1516
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Fax | 203-624-8320
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Provider Business Mailing Address
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Address Line | 200 ORCHARD ST STE 102
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City | NEW HAVEN
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State | CT
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Zip | 06511-5363
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Country | US
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Telephone | 203-624-1516
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Fax | 203-624-8320
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Authorized Official
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Title or Position | OWNER
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Name | DR. LORI K PARAGAS
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Credential | DPM
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Telephone | 203-624-1516
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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 | 000760
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License Number State | CT
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