NPIMap

Organization Active NPI

Riverside Podiatry,LLC

  • Primary Podiatric Medicine Podiatrist
  • Avon, CT
National Provider Identifier
1609354372
Registry record updated Aug 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
881 Issued in CT
Legal business name
RIVERSIDE PODIATRY,LLC
Practice address
11 Westridge Dr
Avon, CT 06001-3648
Phone
(860) 436-1773
NPI assigned
Aug 3, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2018

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

Authorized official

Name
Dr. Japheth Ogamba Mongare, DPM
Title
Podiatrist
Phone
(860) 436-1773

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213EP1101X 881 CT Primary

Addresses

Primary practice location

11 Westridge Dr
Avon, CT 06001-3648

Mailing address

11 Westridge Dr
Avon, CT 06001-3648
Phone (860) 436-1773

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1533254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533254400000",
    "number": "1609354372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 WESTRIDGE DR",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013648",
            "telephone_number": "860-436-1773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 WESTRIDGE DR",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013648",
            "telephone_number": "860-436-1773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE PODIATRY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-03",
        "last_updated": "2018-08-03",
        "status": "A",
        "authorized_official_last_name": "MONGARE",
        "authorized_official_first_name": "JAPHETH",
        "authorized_official_middle_name": "OGAMBA",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "860-436-1773",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "CT",
            "license": "881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2018; 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.