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General NPI Number Information
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NPI Number | 1023299674
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Entity Type | Organization
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Legal Business Name | MODERN PODIATRIC CARE P.C
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Dates
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Enumeration Date | 11/23/2007
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Last Update Date | 01/05/2009
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Provider Practice Location Address
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Address Line | 9204 SPRINGFIELD BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-1857
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Country | US
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Telephone | 718-465-3040
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Fax |
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Provider Business Mailing Address
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Address Line | 11620 190TH ST
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3132
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Country | US
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Telephone | 718-465-3040
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Fax |
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Authorized Official
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Title or Position | PHYSICAN
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Name | MICHAEL C. NWAKANMA
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Credential | DPM
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Telephone | 718-465-3040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 005629
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License Number State | NY
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