Healthcare Provider Details

I. General information

NPI: 1386746816
Provider Name (Legal Business Name): RICHMOND COUNTY PODIATRY FAM FC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 AMSTERDAM AVE
NEW YORK NY
10025-1737
US

IV. Provider business mailing address

PO BOX 140334
STATEN ISLAND NY
10314-0334
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-2930
  • Fax: 770-774-0160
Mailing address:
  • Phone: 212-523-2930
  • Fax: 770-774-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN004938-1
License Number StateNY

VIII. Authorized Official

Name: DR. CARMEN E MCDONALD ASHMAN
Title or Position: PODIATRIST
Credential: MD, DPM
Phone: 212-523-2930