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NPI Code Detail

MEDICARE: FOOTCARE ASSOCIATES OF REGO PARK PC

MEDICARE: FOOTCARE ASSOCIATES OF REGO PARK PC
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
1213EP1101XPrimary Podiatric Medicine Podiatrist0003536NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CM4431OTHERNYRAILROAD MEDICARE

General Provider Information

NPI Number : 1063509537
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOOTCARE ASSOCIATES OF REGO PARK PC
Provider Business Mailing Address
First Line : 9424 63RD DR
Second Line :
City : REGO PARK
State : NY
Zip : 11374-2028
Country : US
Telephone Number : 718-268-0885
Fax Number :
Provider Business Practice Location Address
First Line : 9424 63RD DR
Second Line :
City : REGO PARK
State : NY
Zip : 11374-2028
Country : US
Telephone Number : 718-268-0885
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. PAUL BARRY BERNSTEIN
Credential : DPM
Telephone Number : 718-268-0885
Provider Enumeration Date : 10/06/2006
Last Update Date : 06/06/2011

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