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General NPI Number Information
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NPI Number | 1336445352
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Entity Type | Organization
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Legal Business Name | FRED WARREN D.P.M.,P.C.
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 15274 JEWEL AVE
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City | FLUSHING
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State | NY
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Zip | 11367-1436
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Country | US
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Telephone | 718-261-7373
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Fax | 718-261-7373
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Provider Business Mailing Address
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Address Line | 15274 JEWEL AVE
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City | FLUSHING
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State | NY
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Zip | 11367-1436
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Country | US
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Telephone | 718-261-7373
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Fax | 718-261-7373
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRED WARREN
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Credential | D.P.M.,P.C.
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Telephone | 718-261-7373
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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 | N003300
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License Number State | NY
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