Organization
RIVERSIDE PODIATRY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAPHETH OGAMBA MONGARE DPM (PODIATRIST)
(860) 436-1773
Entity
Organization
Contact information
Practice address
11 WESTRIDGE DR, AVON, CT 06001-3648
(860) 436-1773
Mailing address
11 WESTRIDGE DR, AVON, CT 06001-3648
(860) 436-1773
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
881
CT
Other
Enumeration date
08/03/2018
Last updated
08/03/2018
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