Provider Demographics
NPI:1194901504
Name:ALLEGHENY FOOT & ANKLE CENTER, LLC
Entity type:Organization
Organization Name:ALLEGHENY FOOT & ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GAETANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-625-5537
Mailing Address - Street 1:914 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4263
Mailing Address - Country:US
Mailing Address - Phone:860-443-3838
Mailing Address - Fax:860-443-3839
Practice Address - Street 1:914 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4263
Practice Address - Country:US
Practice Address - Phone:860-443-3838
Practice Address - Fax:860-443-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000645213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU56897Medicare UPIN
CT6209170002Medicare NSC