Healthcare Provider Details

I. General information

NPI: 1962811174
Provider Name (Legal Business Name): NEW YORK FOOT CARE SERVICESPLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 GRAND CONCOURSE APT 1N
BRONX NY
10468-1226
US

IV. Provider business mailing address

3201 GRAND CONCOURSE APT 1N
BRONX NY
10468-1226
US

V. Phone/Fax

Practice location:
  • Phone: 718-365-6363
  • Fax: 866-861-0959
Mailing address:
  • Phone: 718-365-6363
  • Fax: 866-861-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN006621-1
License Number StateNY

VIII. Authorized Official

Name: DR. MCELVIN MATTHEW POPE JR.
Title or Position: PODIATRIST
Credential: DPM
Phone: 917-328-9321