Healthcare Provider Details

I. General information

NPI: 1205932860
Provider Name (Legal Business Name): EPSTEIN TAVROFF LEON DPMS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8475 MAIN ST
BRIARWOOD NY
11435
US

IV. Provider business mailing address

8475 MAIN ST
BRIARWOOD NY
11435-1624
US

V. Phone/Fax

Practice location:
  • Phone: 718-657-8921
  • Fax: 718-657-9650
Mailing address:
  • Phone: 718-657-8921
  • Fax: 718-657-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number005121
License Number StateNY

VIII. Authorized Official

Name: DR. GEOFFREY C EPSTEIN
Title or Position: PARTNER
Credential: DPM
Phone: 718-657-8921