Healthcare Provider Details

I. General information

NPI: 1972792539
Provider Name (Legal Business Name): FAMILY FOOTCARE GROUP LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 STATE ROUTE 97 GROVER HERMANN DIVISION CATSKILL REGIONAL MED CENTER
CALLICOON NY
12723-5052
US

IV. Provider business mailing address

427 BROADWAY STE 2
MONTICELLO NY
12701-1742
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-7741
  • Fax: 845-794-0228
Mailing address:
  • Phone: 845-794-7741
  • Fax: 845-794-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC J HUDES
Title or Position: MANAGING PARTNER
Credential: D.P.M.
Phone: 845-794-7741