Provider Demographics
NPI:1124262910
Name:RIAZATTI, ELLE E (DPM)
Entity type:Individual
Prefix:MS
First Name:ELLE
Middle Name:E
Last Name:RIAZATTI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:714 CHASE PARKWAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3012
Mailing Address - Country:US
Mailing Address - Phone:203-755-0489
Mailing Address - Fax:203-755-7523
Practice Address - Street 1:87 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470
Practice Address - Country:US
Practice Address - Phone:203-270-6724
Practice Address - Fax:203-270-6728
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000689213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400006326Medicare PIN