=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558481135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GETTY SQUARE PODIATRY GROUP PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 02/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 944 N BROADWAY
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-965-1234
-----------------------------------------------------
Fax | 914-963-0700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 944 N BROADWAY
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-965-1234
-----------------------------------------------------
Fax | 914-963-0700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAMES A FISHER
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 914-965-1234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------