Newtown Sports Podiatry

Primary specialty

Sports Medicine PodiatristTaxonomy code 213ES0000X

License

000556 Issued in CT

Legal business name

NEWTOWN SPORTS PODIATRY

Practice address

54 S Main St
Newtown, CT 06470-2358

Phone

(203) 426-7060

Fax

(203) 270-0420

NPI assigned

Aug 4, 2006

Last updated

Mar 9, 2010By 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

Brian W Fullem, DPM

Title

Owner

Phone

(203) 426-7060

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268092800000",
    "number": "1942218763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 S MAIN ST",
            "city": "NEWTOWN",
            "state": "CT",
            "postal_code": "064702358",
            "telephone_number": "203-426-7060",
            "fax_number": "203-270-0420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 S MAIN ST",
            "city": "NEWTOWN",
            "state": "CT",
            "postal_code": "064702358",
            "telephone_number": "203-426-7060",
            "fax_number": "203-270-0420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWTOWN SPORTS PODIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2010-03-09",
        "status": "A",
        "authorized_official_last_name": "FULLEM",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-426-7060",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Sports Medicine",
            "state": "CT",
            "license": "000556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004112851",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lisa H Norcross, BCBA
• Northeast Natural Medicine, LLC

• Podiatrist in Newtown, CT
• Providers in Newtown, CT by specialty
• Podiatrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; 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.