Healthcare Provider Details

I. General information

NPI: 1114978038
Provider Name (Legal Business Name): CAPITAL REGION FOOT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 HACKETT BLVD
ALBANY NY
12209-1525
US

IV. Provider business mailing address

104 HACKETT BLVD
ALBANY NY
12209-1525
US

V. Phone/Fax

Practice location:
  • Phone: 518-465-3515
  • Fax: 518-465-9859
Mailing address:
  • Phone: 518-465-3515
  • Fax: 518-465-9859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number3861
License Number StateNY

VIII. Authorized Official

Name: MARC D GINSBURG
Title or Position: PODIATRIST
Credential: DPM
Phone: 518-465-3515