Healthcare Provider Details

I. General information

NPI: 1932126026
Provider Name (Legal Business Name): ASTORIA FOOT CARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 DITMARS BLVD
ASTORIA NY
11105-2305
US

IV. Provider business mailing address

3117 DITMARS BLVD
ASTORIA NY
11105-2305
US

V. Phone/Fax

Practice location:
  • Phone: 718-274-4040
  • Fax:
Mailing address:
  • Phone: 718-274-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. STEVEN MERMELSTEIN
Title or Position: PARTNER
Credential: DPM
Phone: 718-274-4040