Healthcare Provider Details

I. General information

NPI: 1366133878
Provider Name (Legal Business Name): TLC 4 FEET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD
ALBANY NY
12204-1004
US

IV. Provider business mailing address

5 SAND CREEK RD STE 200
ALBANY NY
12205-1400
US

V. Phone/Fax

Practice location:
  • Phone: 718-362-1411
  • Fax: 718-414-1651
Mailing address:
  • Phone: 518-459-0711
  • Fax: 518-275-0646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS CANDARA
Title or Position: OWNER
Credential: DPM
Phone: 518-459-0711