MEDICARE: STARRETT PODIATRY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	N005753	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023419264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARRETT PODIATRY, LLC

Provider Business Mailing Address
First Line	:	2597 FREDERICK DOUGLAS BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030
Country	:	UM
Telephone Number	:	212-510-7160
Fax Number	:	212-510-7161

Provider Business Practice Location Address
First Line	:	2597 FREDERICK DOUGLASS BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-2105
Country	:	US
Telephone Number	:	212-510-7160
Fax Number	:	212-510-7161

Authorized Official
Title or Position	:	PRACTICE ADMIN.
Name	:	MS. YOLANDA Y FRIERSON
Credential	:
Telephone Number	:	212-534-5009

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	09/08/2014

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Directions to “STARRETT PODIATRY, LLC ” Practice Location

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