Organization
NEWTOWN SPORTS PODIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN W FULLEM DPM (OWNER)
(203) 426-7060
Entity
Organization
Contact information
Practice address
54 S MAIN ST, NEWTOWN, CT 06470-2358
(203) 426-7060
(203) 270-0420
Mailing address
54 S MAIN ST, NEWTOWN, CT 06470-2358
(203) 426-7060
(203) 270-0420
Taxonomy
Speciality
Code
Description
License number
State
213ES0000X
Sports Medicine Podiatrist
Primary
000556
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004112851
—
CT
Enumeration date
08/04/2006
Last updated
03/09/2010
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