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General NPI Number Information
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NPI Number | 1083438014
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Entity Type | Organization
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Legal Business Name | FIFTH AVENUE PODIATRY PLLC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 233 BROADWAY SUITE 1775
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City | NEW YORK
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State | NY
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Zip | 10279
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Country | US
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Telephone | 917-660-1346
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50026
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City | NEWARK
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State | NJ
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Zip | 07101-4403
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Country | US
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Telephone |
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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 | ANA COUTO
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Credential |
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Telephone | 917-660-1346
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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 |
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License Number State |
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