MEDICARE: NEW ENGLAND PODIATRY ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	1948	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003010273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW ENGLAND PODIATRY ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	669 MAIN ST
Second Line	:
City	:	WALTHAM
State	:	MA
Zip	:	02451-0602
Country	:	US
Telephone Number	:	781-891-3311
Fax Number	:	781-891-1315

Provider Business Practice Location Address
First Line	:	669 MAIN ST
Second Line	:
City	:	WALTHAM
State	:	MA
Zip	:	02451-0602
Country	:	US
Telephone Number	:	781-891-3311
Fax Number	:	781-891-1315

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. RONALD BRIAN ETSKOVITZ
Credential	:	D.P.M.
Telephone Number	:	781-891-3311

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	09/15/2011

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