=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366473332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE FAMILY FOOT CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 12/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 658 E 233RD ST
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10466-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-798-9411
-----------------------------------------------------
Fax | 718-798-9409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 658 E 233RD ST
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10466-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-798-9411
-----------------------------------------------------
Fax | 718-798-9409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OFFICER
-----------------------------------------------------
Name | DR. LISA ROTHMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-798-9411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | N005671
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------