MEDICARE: JOHN R TRINIDAD DPM

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	213E00000X	Podiatrist	N002883	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P3201	OTHER		BC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134117476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN R TRINIDAD DPM

Provider Business Mailing Address
First Line	:	193 GREENE AVE
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-3002
Country	:	US
Telephone Number	:	631-589-1706
Fax Number	:	631-218-1863

Provider Business Practice Location Address
First Line	:	193 GREENE AVE
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-3002
Country	:	US
Telephone Number	:	631-589-1706
Fax Number	:	631-218-1863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	11/28/2011

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Directions to “ JOHN R TRINIDAD DPM” Practice Location

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