Provider Demographics
NPI:1043488422
Name:LATIF, AYMAN MAURICE (DPM)
Entity type:Individual
Prefix:DR
First Name:AYMAN
Middle Name:MAURICE
Last Name:LATIF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:AYMAN
Other - Middle Name:MAURICE
Other - Last Name:LATIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:535 SAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4743
Mailing Address - Country:US
Mailing Address - Phone:860-346-5226
Mailing Address - Fax:860-347-6280
Practice Address - Street 1:535 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4743
Practice Address - Country:US
Practice Address - Phone:860-346-5226
Practice Address - Fax:860-347-6280
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00294100213ES0103X
CT000839213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4997100002OtherNSC PROVIDER#
CT4997100006OtherNSC PROVIDER#
CT4997100006OtherNSC PROVIDER#