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General NPI Number Information
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NPI Number | 1831292804
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Entity Type | Organization
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Legal Business Name | ADVANCED PODIATRIC SPECIALISTS, PC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 1389 W MAIN ST SUITE 222
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City | WATERBURY
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State | CT
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Zip | 06708-3104
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Country | US
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Telephone | 203-757-9200
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Fax | 203-757-3990
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Provider Business Mailing Address
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Address Line | 1389 W MAIN ST SUITE 222
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City | WATERBURY
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State | CT
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Zip | 06708-3104
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Country | US
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Telephone | 203-757-9200
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Fax | 203-757-3990
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES T ARENA
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Credential | DPM
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Telephone | 203-757-9200
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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 | P00007
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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 | P00007
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License Number State | CT
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