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General NPI Number Information
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NPI Number | 1922704394
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS PODIATRY P.C.
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 1368 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4303
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Country | US
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Telephone | 718-816-0237
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Fax | 718-816-5465
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Provider Business Mailing Address
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Address Line | 35 ABINGDON CT
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City | STATEN ISLAND
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State | NY
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Zip | 10308-1345
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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 | PODIATRIST
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Name | KAWSAR IBRAHIM
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Credential |
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Telephone | 917-409-6505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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