MEDICARE: MIDDLE VILLAGE PODIATRY, 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	N005171	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
2	1376541672	OTHER		NPI
3	480026853	OTHER	NY	MC RR

General Provider Information

NPI Number	:	1780895888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLE VILLAGE PODIATRY, PC

Provider Business Mailing Address
First Line	:	6412 FRESH POND RD
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-3331
Country	:	US
Telephone Number	:	718-497-3000
Fax Number	:	718-497-3335

Provider Business Practice Location Address
First Line	:	6412 FRESH POND RD
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-3331
Country	:	US
Telephone Number	:	718-497-3000
Fax Number	:	718-497-3335

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KAREN M AGLIETTI
Credential	:	D.P.M.
Telephone Number	:	718-497-3000

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	11/10/2011

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