Healthcare Provider Details

I. General information

NPI: 1124102520
Provider Name (Legal Business Name): GENERAL PODIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PUTTERS CT
STATEN ISLAND NY
10301-3364
US

IV. Provider business mailing address

10 PUTTERS CT
STATEN ISLAND NY
10301-3364
US

V. Phone/Fax

Practice location:
  • Phone: 718-720-8372
  • Fax: 718-720-1304
Mailing address:
  • Phone: 718-934-7500
  • Fax: 718-504-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: EWA D'SILVA
Title or Position: PRESIDENT
Credential: DPM
Phone: 718-934-7500