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General NPI Number Information
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NPI Number | 1063509537
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Entity Type | Organization
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Legal Business Name | FOOTCARE ASSOCIATES OF REGO PARK PC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 9424 63RD DR
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City | REGO PARK
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State | NY
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Zip | 11374-2028
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Country | US
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Telephone | 718-268-0885
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Fax |
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Provider Business Mailing Address
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Address Line | 9424 63RD DR
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City | REGO PARK
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State | NY
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Zip | 11374-2028
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Country | US
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Telephone | 718-268-0885
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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. PAUL BARRY BERNSTEIN
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Credential | DPM
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Telephone | 718-268-0885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 0003536
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License Number State | NY
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