Healthcare Provider Details

I. General information

NPI: 1437552007
Provider Name (Legal Business Name): ABBOTT FOOTCARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W 98TH ST
NEW YORK NY
10025-5661
US

IV. Provider business mailing address

220 W 98TH ST
NEW YORK NY
10025-5661
US

V. Phone/Fax

Practice location:
  • Phone: 212-663-3668
  • Fax:
Mailing address:
  • Phone: 212-663-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number004442
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number004442
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number004442
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number004442
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number004442
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number004442
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number004442
License Number StateNY

VIII. Authorized Official

Name: HERBERT ABBOTT
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 303-704-5550