# FOOTSTAR PEDORTHIC CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295053668
- **Authorized official:** MATTHEW ARCIVOLO (OWNER)
- **Authorized official phone:** (800) 318-0007

## Contact information

- **Practice address:** 74 BROAD ST, MILFORD, CT 06460-3353
- **Practice address phone:** (800) 318-0007
- **Mailing address:** 74 BROAD ST, MILFORD, CT 06460-3353
- **Mailing address phone:** (800) 318-0007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335E00000X | Prosthetic/Orthotic Supplier | 2391 | CT | Yes |

## Other

- **Enumeration date:** 05/11/2010
- **Last updated:** 05/11/2010