MEDICARE: JUSTIN WERNICK 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	213EP1101X	Primary Podiatric Medicine Podiatrist	2032	NY

General Provider Information

NPI Number	:	1922193416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN WERNICK DPM

Provider Business Mailing Address
First Line	:	96 5TH AVENUE #6J
Second Line	:
City	:	NYC
State	:	NY
Zip	:	10011
Country	:	US
Telephone Number	:	212-243-5516
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 EAST 124 TH STREET
Second Line	:
City	:	NY
State	:	NY
Zip	:	10035
Country	:	US
Telephone Number	:	212-410-8036
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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