MEDICARE: HOWARD BEACH PODIATRY 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
1	261QP1100X	Podiatric Clinic/Center	N006254	NY

General Provider Information

NPI Number	:	1083029300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOWARD BEACH PODIATRY PC

Provider Business Mailing Address
First Line	:	15905 92ND ST
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-3123
Country	:	US
Telephone Number	:	718-845-0741
Fax Number	:	718-835-1453

Provider Business Practice Location Address
First Line	:	15905 92ND ST
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-3123
Country	:	US
Telephone Number	:	718-845-0741
Fax Number	:	718-835-1453

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VEENA MANI
Credential	:	DPM
Telephone Number	:	718-845-0741

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	06/25/2014

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