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General NPI Number Information
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NPI Number | 1174772446
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Entity Type | Organization
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Legal Business Name | THE FOOT SPECIALTY PRACTICE, P.C.
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 903 UTICA AVE 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11203-4313
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Country | US
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Telephone | 718-493-5986
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Fax | 646-843-4712
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Provider Business Mailing Address
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Address Line | 903 UTICA AVE 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11203-4313
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Country | US
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Telephone | 718-493-5986
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Fax | 646-843-4712
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. CARL MYREL JEAN
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Credential | D.P.M.
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Telephone | 718-522-2770
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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 | N006209
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License Number State | NY
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