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General NPI Number Information
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NPI Number | 1023406196
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Entity Type | Organization
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Legal Business Name | ELITE FOOT CARE NYNJ
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Dates
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Enumeration Date | 12/24/2014
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Last Update Date | 12/24/2014
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Provider Practice Location Address
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Address Line | 75 WALL ST SUITE 19G
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City | NEW YORK
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State | NY
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Zip | 10005-2833
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Country | US
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Telephone | 718-218-4075
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Fax |
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Provider Business Mailing Address
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Address Line | 11 GRANT AVE
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City | EAST HANOVER
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State | NJ
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Zip | 07936-2950
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Country | US
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Telephone | 718-218-4075
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL GENKIN
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Credential | DPM
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Telephone | 718-218-4075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00321600
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License Number State | NJ
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