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General NPI Number Information
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NPI Number | 1316477649
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Entity Type | Organization
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Legal Business Name | COLUMBUS CIRCLE PODIATRIC SURGICAL, PC
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 315 W 57TH ST STE 407
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City | NEW YORK
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State | NY
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Zip | 10019-3147
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Country | US
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Telephone | 212-706-0790
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Fax | 212-706-0791
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Provider Business Mailing Address
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Address Line | 315 W 57TH ST STE 407
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City | NEW YORK
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State | NY
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Zip | 10019-3147
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Country | US
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Telephone | 212-706-0790
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Fax | 212-706-0791
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRED DE LUCIA
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Credential | DPM
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Telephone | 212-706-0790
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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 | AN006275
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License Number State | NY
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