Healthcare Provider Details

I. General information

NPI: 1215325899
Provider Name (Legal Business Name): ADVOCATE BRONX FOOT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 MORRIS PARK AVE SUITE 3B
BRONX NY
10461-1400
US

IV. Provider business mailing address

1120 MORRIS PARK AVE SUITE 3B
BRONX NY
10461-1400
US

V. Phone/Fax

Practice location:
  • Phone: 718-409-2121
  • Fax: 718-655-3475
Mailing address:
  • Phone: 718-409-2121
  • Fax: 718-655-3475

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: JALU PATEL
Title or Position: PARTNER
Credential: DPM
Phone: 718-409-2121