Healthcare Provider Details

I. General information

NPI: 1689929374
Provider Name (Legal Business Name): HUGUENOT PODIATRY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 SEGUINE AVE UNIT 2
STATEN ISLAND NY
10309-3723
US

IV. Provider business mailing address

62 SEGUINE AVE UNIT 2
STATEN ISLAND NY
10309-3723
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-3838
  • Fax: 718-948-3838
Mailing address:
  • Phone: 718-948-3838
  • Fax: 718-948-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MARIANNE LANTS
Title or Position: PODIATRIST
Credential: DPM
Phone: 718-948-3838