Provider Demographics
NPI:1427686815
Name:CONNECTICUT PODIATRY PARTNERS, PLLC
Entity type:Organization
Organization Name:CONNECTICUT PODIATRY PARTNERS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-626-5581
Mailing Address - Street 1:850 N MAIN STREET EXT STE 2A2
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2483
Mailing Address - Country:US
Mailing Address - Phone:203-626-5581
Mailing Address - Fax:
Practice Address - Street 1:850 N MAIN STREET EXT STE 2A2
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2483
Practice Address - Country:US
Practice Address - Phone:203-626-5581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty