Healthcare Provider Details

I. General information

NPI: 1437393048
Provider Name (Legal Business Name): THE NEW YORK PODIATRY ASSOCIATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 BATH AVE
BROOKLYN NY
11214
US

IV. Provider business mailing address

2015 BATH AVE
BROOKLYN NY
11214
US

V. Phone/Fax

Practice location:
  • Phone: 718-787-9288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number006000
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number006000
License Number StateNY

VIII. Authorized Official

Name: OSCAR ETUK
Title or Position: DPM/OWNER
Credential:
Phone: 718-787-9288