Healthcare Provider Details

I. General information

NPI: 1285949180
Provider Name (Legal Business Name): NYC PODIATRIC MEDICINE AND SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10914 ASCAN AVE STE 1A
FOREST HILLS NY
11375-7804
US

IV. Provider business mailing address

6456 DIETERLE CRES
REGO PARK NY
11374-5027
US

V. Phone/Fax

Practice location:
  • Phone: 718-371-4400
  • Fax: 718-371-5400
Mailing address:
  • Phone: 718-371-4400
  • Fax: 718-371-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN006350
License Number StateNY

VIII. Authorized Official

Name: DR. EVELYN G CAVALIER
Title or Position: PRESIDENT
Credential: DPM
Phone: 718-371-4400