Healthcare Provider Details

I. General information

NPI: 1659182111
Provider Name (Legal Business Name): FOOTCARE NOW PODIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2747 CRESCENT ST
ASTORIA NY
11102-3142
US

IV. Provider business mailing address

718 BROUGHTON ST
ORANGEBURG SC
29115-6648
US

V. Phone/Fax

Practice location:
  • Phone: 701-898-3668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEVIN L. RAY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DPM
Phone: 917-405-7881