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General NPI Number Information
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NPI Number | 1255754917
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Entity Type | Organization
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Legal Business Name | IDEAL FOOT CARE PC
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 3116 30TH AVE SUITE 203
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City | ASTORIA
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State | NY
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Zip | 11102-1571
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Country | US
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Telephone | 718-545-3338
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Fax | 718-626-3034
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Provider Business Mailing Address
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Address Line | 3116 30TH AVE SUITE 203
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City | ASTORIA
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State | NY
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Zip | 11102-1571
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Country | US
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Telephone | 718-545-3338
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Fax | 718-626-3034
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. ALBERT SAMANDAROV
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Credential | D.P.M
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Telephone | 718-545-3338
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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 | 006526
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License Number State | NY
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