MEDICARE: CONNECTICUT PODIATRY PARTNERS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1427686815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTICUT PODIATRY PARTNERS, PLLC

Provider Business Mailing Address
First Line	:	850 N MAIN STREET EXT STE 2A2
Second Line	:
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-2483
Country	:	US
Telephone Number	:	203-626-5581
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 N MAIN STREET EXT STE 2A2
Second Line	:
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-2483
Country	:	US
Telephone Number	:	203-626-5581
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. ROSA BRUNELLE
Credential	:
Telephone Number	:	203-626-5581

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	11/27/2023

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