MEDICARE: AVENUE U PODIATRY,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	N004476	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480026837	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1053414300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVENUE U PODIATRY,P.C.

Provider Business Mailing Address
First Line	:	164 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3740
Country	:	US
Telephone Number	:	718-996-8420
Fax Number	:	718-714-6787

Provider Business Practice Location Address
First Line	:	164 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3740
Country	:	US
Telephone Number	:	718-996-8420
Fax Number	:	718-714-6787

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES GREGG MARCESE
Credential	:	DPM
Telephone Number	:	718-996-8420

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/26/2008

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