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General NPI Number Information
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NPI Number | 1548700636
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Entity Type | Organization
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Legal Business Name | ESSENTIAL PODIATRY PC
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 23 SARATOGA ST
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City | TAPPAN
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State | NY
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Zip | 10983-2620
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Country | US
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Telephone | 845-642-8851
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Fax | 914-328-2467
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Provider Business Mailing Address
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Address Line | 23 SARATOGA ST
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City | TAPPAN
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State | NY
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Zip | 10983-2620
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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 | DPM/PRESIDENT
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Name | SOOJI KIM
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Credential |
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Telephone | 845-642-8851
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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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