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General NPI Number Information
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NPI Number | 1881785012
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Entity Type | Organization
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Legal Business Name | COMPLETE FOOT CARE, LLC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 09/12/2008
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Provider Practice Location Address
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Address Line | 60 TEMPLE ST
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City | NEW HAVEN
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State | CT
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Zip | 06513-2716
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Country | US
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Telephone | 203-562-7688
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Fax | 203-624-3131
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Provider Business Mailing Address
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Address Line | 60 TEMPLE ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-2716
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Country | US
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Telephone | 203-562-7688
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Fax | 203-624-3131
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Authorized Official
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Title or Position | MEMBER
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Name | DR. NEAL BRADLEY ZOMBACK
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Credential | D.P.M.
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Telephone | 203-562-7688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | 466
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 762
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 000466
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 466
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License Number State | CT
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