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NPI Code Detail

MEDICARE: RUSSELL F TRAHAN D D P M P C

MEDICARE: RUSSELL F TRAHAN D D P M 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
1213E00000XPodiatrist003996NY

General Provider Information

NPI Number : 1023356318
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUSSELL F TRAHAN D D P M P C
Provider Business Mailing Address
First Line : 247 W 145TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10039-4004
Country : US
Telephone Number : 212-281-9300
Fax Number : 212-491-7984
Provider Business Practice Location Address
First Line : 247 W 145TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10039-4004
Country : US
Telephone Number : 212-281-9300
Fax Number : 212-491-7984
Authorized Official
Title or Position : OWNER
Name : DR. RUSSELL TRAHAN
Credential : DPM
Telephone Number : 212-281-9300
Provider Enumeration Date : 01/22/2013
Last Update Date : 03/21/2013

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Directions to “RUSSELL F TRAHAN D D P M P C ” Practice Location

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