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General NPI Number Information
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NPI Number | 1568782696
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE SURGEONS OF BROOKLYN
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 1545 ATLANTIC AVE STE 108
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City | BROOKLYN
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State | NY
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Zip | 11213-1122
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Country | US
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Telephone | 718-484-3888
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Fax | 718-622-7177
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Provider Business Mailing Address
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Address Line | 1545 ATLANTIC AVE STE 108
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City | BROOKLYN
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State | NY
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Zip | 11213-1122
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Country | US
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Telephone | 718-484-3888
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Fax | 718-622-7177
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Authorized Official
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Title or Position | OWNER
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Name | DR. SIMON RASKIN
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Credential | DPM
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Telephone | 718-484-3888
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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 | N005608
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License Number State | NY
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