Advanced Podiatric Specialists, PC
Organization Active NPI Podiatrist · Waterbury, CT
NPI 1831292804 · NPPES record last updated Jun 3, 2014
Key facts
- NPI
- 1831292804
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- License
- P00007 (CT)
- Legal business name
- ADVANCED PODIATRIC SPECIALISTS, PC
- Practice address
- 1389 W Main St
Suite 222
Waterbury, CT 06708-3104 - Phone
- (203) 757-9200
- Fax
- (203) 757-3990
- NPI assigned
- Sep 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Charles T Arena, DPM
- Title
- Owner
- Phone
- (203) 757-9200
Practitioners 7
-
Charles T Arena, DPM
-
Peter A Blume, DPMFACFAS
-
Ryan J Donegan, DPM
-
Patrick Fettinger, DPM
-
John Michael Gaetano, DPM FACFAS
-
Eric Lui, DPM
-
Sherwin M Tucker, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061006000230 | CT | Part B Supplier - Clinic/Group Practice | 6901802461 |
Receives reassigned benefits from 3 practitioners Practice locations: Waterbury, CT |
| O20100930099714 | CT | DME Supplier - Physician - Podiatry | 6901802461 | Practice locations: Waterbury, CT |
National Provider Directory
Locations
1389 W Main St
Ste 222
Waterbury, CT 06708
Phone (203) 757-9200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | P00007 | CT | Yes |
| Prosthetic/Orthotic Supplier | 335E00000X | P00007 | CT |
Addresses
Primary practice location
1389 W Main St
Suite 222
Waterbury, CT 06708-3104
Mailing address
1389 W Main St
Suite 222
Waterbury, CT 06708-3104
Phone (203) 757-9200
Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.