MEDICARE: TYSON FOOT CARE, PC

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	SC002069L	PA

General Provider Information

NPI Number	:	1487806220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYSON FOOT CARE, PC

Provider Business Mailing Address
First Line	:	7001 LARGE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1725
Country	:	US
Telephone Number	:	215-342-8124
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 LARGE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1725
Country	:	US
Telephone Number	:	215-342-8124
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HARVEY A BERNSTEIN
Credential	:	DPM
Telephone Number	:	215-342-8124

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/10/2008

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