Healthcare Provider Details

I. General information

NPI: 1699945030
Provider Name (Legal Business Name): E YOUNGEWIRTH DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 BROADWAY
NEW YORK NY
10034-3119
US

IV. Provider business mailing address

4915 BROADWAY
NEW YORK NY
10034-3119
US

V. Phone/Fax

Practice location:
  • Phone: 212-567-6126
  • Fax:
Mailing address:
  • Phone: 212-567-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRIAN FLORES
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 718-313-0438