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General NPI Number Information
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NPI Number | 1538767850
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Entity Type | Organization
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Legal Business Name | MA PODIATRY PLLC
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 970 N BROADWAY STE 206
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City | YONKERS
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State | NY
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Zip | 10701-1310
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Country | US
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Telephone | 646-639-5291
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Fax | 914-664-2873
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Provider Business Mailing Address
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Address Line | 3950 60TH ST APT A35
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City | WOODSIDE
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State | NY
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Zip | 11377-3421
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JOHN EDWARD
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Credential |
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Telephone | 646-639-5291
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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 |
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License Number State |
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