Healthcare Provider Details

I. General information

NPI: 1255754917
Provider Name (Legal Business Name): IDEAL FOOT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 30TH AVE SUITE 203
ASTORIA NY
11102-1571
US

IV. Provider business mailing address

3116 30TH AVE SUITE 203
ASTORIA NY
11102-1571
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-3338
  • Fax: 718-626-3034
Mailing address:
  • Phone: 718-545-3338
  • Fax: 718-626-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006526
License Number StateNY

VIII. Authorized Official

Name: DR. ALBERT SAMANDAROV
Title or Position: PODIATRIST
Credential: D.P.M
Phone: 718-545-3338