Healthcare Provider Details

I. General information

NPI: 1659542769
Provider Name (Legal Business Name): FAMILY FOOT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 CENTRAL AVE
ALBANY NY
12205-5272
US

IV. Provider business mailing address

1315 CENTRAL AVE
ALBANY NY
12205-5272
US

V. Phone/Fax

Practice location:
  • Phone: 518-689-5390
  • Fax: 518-689-5396
Mailing address:
  • Phone: 518-689-5390
  • Fax: 518-689-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004801
License Number StateNY

VIII. Authorized Official

Name: MR. DAVID PICCHIONE
Title or Position: PARTNER
Credential: DPM
Phone: 518-758-1331