Mt Medical, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

MT MEDICAL, LLC

Doing business as

Comfort Footwear Etc

Practice address

208 Park Rd
West Hartford, CT 06119-2015

Phone

(860) 232-1868

Fax

(860) 761-2658

NPI assigned

Jul 13, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Ilya Tsvok, C-PED

Title

President

Phone

(860) 232-1868

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Comfort Footwear Etc Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595203200000",
    "number": "1609891597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 PARK RD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061192015",
            "telephone_number": "860-232-1868",
            "fax_number": "860-761-2658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 PARK RD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061192015",
            "telephone_number": "860-232-1868",
            "fax_number": "860-761-2658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A",
        "authorized_official_last_name": "TSVOK",
        "authorized_official_first_name": "ILYA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-232-1868",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C-PED"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004214269",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comfort Footwear Etc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert Moss, M.D.
• Roberta J Moss, MD
• Lisa M Mowry, M.A. CCC
• Hannah Rose Moyzes, OD
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• Dana Muller, RN
• Dorothy Rose Mulligan, OD
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• Alison Murphy

• Prosthetic/Orthotic Supplier in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Prosthetic/Orthotic Supplier in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.