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General NPI Number Information
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NPI Number | 1508137522
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Entity Type | Organization
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Legal Business Name | PODIATRIC CARE & DIAGNOSTICS, PC
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 8835 164TH ST SUITE DN
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City | JAMAICA
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State | NY
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Zip | 11432-4056
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Country | US
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Telephone | 718-206-0011
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Fax | 718-206-9856
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Provider Business Mailing Address
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Address Line | 8835 164TH ST SUITE DN
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City | JAMAICA
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State | NY
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Zip | 11432-4056
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Country | US
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Telephone | 718-206-0011
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Fax | 718-206-9856
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. RONALD J BEAUVAIS
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Credential | DPM
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Telephone | 718-206-0011
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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 |
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License Number State |
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