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General NPI Number Information
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NPI Number | 1063748887
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Entity Type | Organization
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Legal Business Name | MOUNT KISCO PODIATRY ASSOCIATES, PC
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 101 S BEDFORD RD STE 214
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City | MOUNT KISCO
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State | NY
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Zip | 10549-3454
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Country | US
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Telephone | 914-244-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 101 S BEDFORD RD STE 214
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City | MOUNT KISCO
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State | NY
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Zip | 10549-3454
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Country | US
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Telephone | 914-244-3338
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. RACHEL JUBAK
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Credential |
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Telephone | 914-244-3338
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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 | 006195
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License Number State | NY
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