Healthcare Provider Details

I. General information

NPI: 1710351242
Provider Name (Legal Business Name): GENERAL PODIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 US HIGHWAY 9
MANALAPAN NJ
07726-3073
US

IV. Provider business mailing address

10 PUTTERS CT
STATEN ISLAND NY
10301-3364
US

V. Phone/Fax

Practice location:
  • Phone: 732-617-9999
  • Fax: 718-720-1304
Mailing address:
  • Phone: 718-720-8372
  • Fax: 718-720-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD0024540
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. EWA D'SILVA
Title or Position: DPM
Credential: DPM
Phone: 718-720-8372