Countryside Pedorthics & Cobbler Shop

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

1510 Issued in CT

Legal business name

COUNTRYSIDE PEDORTHICS & COBBLER SHOP

Practice address

95 Bingham Rd
Canterbury, CT 06331-1302

Phone

(860) 546-1099

Fax

(860) 546-1095

NPI assigned

Oct 31, 2007

Last updated

Apr 22, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ronald G. Auger, CPED

Title

Owner/Certified Pedorthist

Phone

(860) 546-1099

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619049600000",
    "number": "1265611891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 BINGHAM ROAD",
            "city": "CANTERBURY",
            "state": "CT",
            "postal_code": "06331",
            "telephone_number": "860-546-1099",
            "fax_number": "860-546-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 BINGHAM RD",
            "city": "CANTERBURY",
            "state": "CT",
            "postal_code": "063311302",
            "telephone_number": "860-546-1099",
            "fax_number": "860-546-1095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE PEDORTHICS & COBBLER SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-31",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A",
        "authorized_official_last_name": "AUGER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER/CERTIFIED PEDORTHIST",
        "authorized_official_telephone_number": "860-546-1099",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPED"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CT",
            "license": "1510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004069993",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Canterbury Volunteer Fire Company Inc
• Cantwell Physical Therapy, LLC
• Bianca Cantwell, PT,DPT
• Patricia A Clauson, MASSAGE THERAPIST
• Heidi Clement, OTR/L
• Glenn M. Frederick
• Grow With Me Pediatrics LLC
• Pamela A. Kerouack-Warner, LPC
• Kurt Lavimoniere, LPC
• Shannon Jean Loffredo, DPT

• Durable Medical Equipment & Medical Supplies in Canterbury, CT
• Providers in Canterbury, CT by specialty
• Durable Medical Equipment & Medical Supplies in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.