Provider Demographics
NPI:1811292675
Name:CONNECTICUT FOOT AND ANKLE ASSOCIATES, INC
Entity type:Organization
Organization Name:CONNECTICUT FOOT AND ANKLE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-936-6677
Mailing Address - Street 1:245 AMITY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2258
Mailing Address - Country:US
Mailing Address - Phone:203-936-6677
Mailing Address - Fax:203-774-3594
Practice Address - Street 1:245 AMITY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2258
Practice Address - Country:US
Practice Address - Phone:203-936-6677
Practice Address - Fax:203-774-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000781332B00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008034121Medicaid
CT008034121Medicaid
CTD100040145Medicare PIN