Healthcare Provider Details

I. General information

NPI: 1487997482
Provider Name (Legal Business Name): SANA TROVATO D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PLACE
BRONX NY
10461-2720
US

IV. Provider business mailing address

1250 WATERS PLACE
BRONX NY
10461-2720
US

V. Phone/Fax

Practice location:
  • Phone: 347-577-4410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00330600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: