MEDICARE: AFFILIATED PODIATRISTS LLC

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	213ES0131X	Foot Surgery Podiatrist	000749	CT
2	213EP1101X	Primary Podiatric Medicine Podiatrist	000749	CT
3	213EP0504X	Public Medicine Podiatrist	000749	CT
4	213ER0200X	Radiology Podiatrist	000749	CT
5	213ES0000X	Sports Medicine Podiatrist	000749	CT
6	332B00000X	Durable Medical Equipment & Medical Supplies	000749	CT
7	213E00000X	Podiatrist	000749	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00058892	OTHER	CT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9577804	OTHER	CT	CIGNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P2630726	OTHER	CT	OXFORD
5	030000749CT02	OTHER	CT	ANTHEM

General Provider Information

NPI Number	:	1710988985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFILIATED PODIATRISTS LLC

Provider Business Mailing Address
First Line	:	2A TOPSTONE DR
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2624
Country	:	US
Telephone Number	:	203-942-9141
Fax Number	:

Provider Business Practice Location Address
First Line	:	2A TOPSTONE DR
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2624
Country	:	US
Telephone Number	:	203-942-9141
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. SAMIR F ZAKY
Credential	:
Telephone Number	:	203-942-9141

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	06/11/2008

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Directions to “AFFILIATED PODIATRISTS LLC ” Practice Location

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