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General NPI Number Information
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NPI Number | 1811955057
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE FAMILY FOOT CENTER LLC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 210 S MAIN ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3764
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Country | US
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Telephone | 860-638-4671
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Fax | 860-638-4673
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Provider Business Mailing Address
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Address Line | 210 S MAIN ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3764
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Country | US
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Telephone | 860-638-4671
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Fax | 860-638-4673
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Authorized Official
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Title or Position | DIRECTOR OFFICER
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Name | DR. DEBORAH E WATERMAN
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Credential | D.P.M.
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Telephone | 860-638-4671
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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 | 000735
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000735
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License Number State | CT
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