=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053627463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH ROCKLAND PODIATRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2010
-----------------------------------------------------
Last Update Date | 12/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 LIBERTY SQUARE MALL
-----------------------------------------------------
City | STONY POINT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10980-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-429-0520
-----------------------------------------------------
Fax | 845-429-0603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 LIBERTY SQUARE MALL
-----------------------------------------------------
City | STONY POINT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10980-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-429-0520
-----------------------------------------------------
Fax | 845-429-0630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PETER COSTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-429-0520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | N3910-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------