Provider Demographics
NPI:1881785012
Name:COMPLETE FOOT CARE, LLC
Entity type:Organization
Organization Name:COMPLETE FOOT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:ZOMBACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-562-7688
Mailing Address - Street 1:60 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2716
Mailing Address - Country:US
Mailing Address - Phone:203-562-7688
Mailing Address - Fax:203-624-3131
Practice Address - Street 1:60 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-2716
Practice Address - Country:US
Practice Address - Phone:203-562-7688
Practice Address - Fax:203-624-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT466213ES0000X, 213E00000X
CT762213ES0131X
CT000466332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1730101635OtherNPI- NEAL ZOMBACK, DPM
CT1992712236OtherNPI-DR SCOTT MELAMED
CT004180650OtherMEDICAID GROUP
CT480000984OtherMEDICARE ID- SCOTT MELAMED, DPM
CT004090528Medicaid
CT480000982OtherMEDICARE ID- NEAL B ZOMBACK, DPM
CT004222999Medicaid
CT004222999Medicaid
CTT23199Medicare UPIN
CTC03595Medicare PIN