Healthcare Provider Details

I. General information

NPI: 1558532911
Provider Name (Legal Business Name): STATEN ISLAND PODIATRY OBS,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 BARD AVE
STATEN ISLAND NY
10301-3322
US

IV. Provider business mailing address

970 BARD AVE
STATEN ISLAND NY
10301-3322
US

V. Phone/Fax

Practice location:
  • Phone: 718-720-6866
  • Fax: 718-720-6913
Mailing address:
  • Phone: 718-720-6866
  • Fax: 718-720-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD JOSEPH FERDINANDO
Title or Position: MEDICAL DIRECTOR
Credential: DPM
Phone: 718-720-6866