MEDICARE: NEW YORK PODIATRIC MEDICINE AND FOOT SPECIALISTS, LLP

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	006013	NY

General Provider Information

NPI Number	:	1033219258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK PODIATRIC MEDICINE AND FOOT SPECIALISTS, LLP

Provider Business Mailing Address
First Line	:	110 LAFAYETTE ST RM 603
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4116
Country	:	US
Telephone Number	:	212-274-9988
Fax Number	:	212-274-1172

Provider Business Practice Location Address
First Line	:	110 LAFAYETTE ST RM 603
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4116
Country	:	US
Telephone Number	:	212-274-9988
Fax Number	:	212-274-1172

Authorized Official
Title or Position	:	D.P.M.
Name	:	DORENE SOO-HOO
Credential	:	D.P.M.
Telephone Number	:	212-274-9988

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/22/2020

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