Healthcare Provider Details

I. General information

NPI: 1285072827
Provider Name (Legal Business Name): FIELDS FOOT AND ANKLE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 WEBSTER AVE
BRONX NY
10467-4926
US

IV. Provider business mailing address

3112 WEBSTER AVE
BRONX NY
10467-4926
US

V. Phone/Fax

Practice location:
  • Phone: 718-655-3410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number65006558
License Number StateNY

VIII. Authorized Official

Name: RICHARD FIELDS
Title or Position: CEO
Credential: DPM
Phone: 310-383-7707