Healthcare Provider Details

I. General information

NPI: 1427297340
Provider Name (Legal Business Name): D & V PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 MAYFAIR DRIVE
BROOKLYN NY
11234
US

IV. Provider business mailing address

389 MAYFAIR DRIVE
BROOKLYN NY
11234
US

V. Phone/Fax

Practice location:
  • Phone: 718-838-4995
  • Fax:
Mailing address:
  • Phone: 718-838-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number006233
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number006233
License Number StateNY

VIII. Authorized Official

Name: DORA VALDBERG
Title or Position: OWNER
Credential: DPM
Phone: 718-838-4995