Healthcare Provider Details

I. General information

NPI: 1821272782
Provider Name (Legal Business Name): TENDER FOOT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 67TH AVE SUITE1S
FOREST HILLS NY
11375-2455
US

IV. Provider business mailing address

10230 67TH AVE SUITE1S
FOREST HILLS NY
11375-2455
US

V. Phone/Fax

Practice location:
  • Phone: 718-275-7590
  • Fax:
Mailing address:
  • Phone: 718-275-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number005404
License Number StateNY

VIII. Authorized Official

Name: DR. ELVIRA CALLAHAN
Title or Position: OWNER
Credential: DPM
Phone: 718-275-7590