Healthcare Provider Details

I. General information

NPI: 1922704394
Provider Name (Legal Business Name): FOUNDATIONS PODIATRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 CLOVE RD
STATEN ISLAND NY
10301-4303
US

IV. Provider business mailing address

35 ABINGDON CT
STATEN ISLAND NY
10308-1345
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-0237
  • Fax: 718-816-5465
Mailing address:
  • Phone:
  • 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 Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAWSAR IBRAHIM
Title or Position: PODIATRIST
Credential:
Phone: 917-409-6505