MEDICARE: FIELDS FOOT AND ANKLE CORP.

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	65006558	NY

General Provider Information

NPI Number	:	1285072827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIELDS FOOT AND ANKLE CORP.

Provider Business Mailing Address
First Line	:	3112 WEBSTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-4926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3112 WEBSTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-4926
Country	:	US
Telephone Number	:	718-655-3410
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RICHARD FIELDS
Credential	:	DPM
Telephone Number	:	310-383-7707

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	06/05/2013

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