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NPI Code Detail

MEDICARE: 21ST CENTURY FOOTCARE PC

MEDICARE: 21ST CENTURY FOOTCARE 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
1213ES0103XFoot & Ankle Surgery PodiatristN0034811NY

General Provider Information

NPI Number : 1861564148
Entity Type Code : Organization
Provider Name (Legal Business Name) : 21ST CENTURY FOOTCARE PC
Provider Business Mailing Address
First Line : 24 BRENTWOOD RD
Second Line :
City : BAY SHORE
State : NY
Zip : 11706-8011
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 24 BRENTWOOD RD
Second Line :
City : BAY SHORE
State : NY
Zip : 11706-8011
Country : US
Telephone Number : 631-666-8100
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : JULIANN DARIN
Credential :
Telephone Number : 631-666-8100
Provider Enumeration Date : 11/14/2006
Last Update Date : 06/11/2010

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Directions to “21ST CENTURY FOOTCARE PC ” Practice Location

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