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General NPI Number Information
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NPI Number | 1932363066
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Entity Type | Organization
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Legal Business Name | LAKE GROVE FOOT CARE PC
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 2701 MIDDLE COUNTRY RD SUITE #1
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City | LAKE GROVE
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State | NY
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Zip | 11755-2117
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Country | US
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Telephone | 631-981-5287
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Fax | 631-981-5288
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Provider Business Mailing Address
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Address Line | 2701 MIDDLE COUNTRY RD SUITE #1
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City | LAKE GROVE
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State | NY
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Zip | 11755-2117
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Country | US
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Telephone | 631-981-5287
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Fax | 631-981-5288
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MARC ANDREW FOUCHER
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Credential | DPM
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Telephone | 631-981-5287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N005144
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License Number State | NY
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