MEDICARE: PEDIRITE MEDICAL NJ LLC

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

General Provider Information

NPI Number	:	1942850250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIRITE MEDICAL NJ LLC

Provider Business Mailing Address
First Line	:	267 BROADWAY FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-6216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	267 BROADWAY FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-6216
Country	:	US
Telephone Number	:	212-764-0008
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACOB FINESTONE
Credential	:
Telephone Number	:	212-734-6621

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	05/26/2026

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Directions to “PEDIRITE MEDICAL NJ LLC ” Practice Location

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