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General NPI Number Information
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NPI Number | 1164586723
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Entity Type | Organization
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Legal Business Name | 5TH AVENUE PODIATRY, PC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 36 W 44TH ST SUITE 401
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City | NEW YORK
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State | NY
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Zip | 10036-8102
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Country | US
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Telephone | 212-768-7999
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Fax | 212-398-8356
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Provider Business Mailing Address
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Address Line | 36 W 44TH ST SUITE 401
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City | NEW YORK
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State | NY
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Zip | 10036-8102
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Country | US
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Telephone | 212-768-7999
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Fax | 212-398-8356
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BEN DIMICHINO
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Credential | D.P.M.
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Telephone | 212-768-7999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N004656
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License Number State | NY
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