Healthcare Provider Details

I. General information

NPI: 1104902972
Provider Name (Legal Business Name): FOOT AND ANKLE ORTHOPAEDIC SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 E 72ND ST ROOM 509
NEW YORK NY
10021-4099
US

IV. Provider business mailing address

523 E 72ND ST ROOM 509
NEW YORK NY
10021-4099
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1579
  • Fax:
Mailing address:
  • Phone: 212-606-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: MARTIN J O'MALLEY
Title or Position: MANAGER
Credential: M.D.
Phone: 212-606-1579