MEDICARE: HARVARD PODIATRY

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	PO2030	FL

General Provider Information

NPI Number	:	1104094044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVARD PODIATRY

Provider Business Mailing Address
First Line	:	4430 SHERIDAN ST STE A
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3546
Country	:	US
Telephone Number	:	954-966-7770
Fax Number	:	954-966-9742

Provider Business Practice Location Address
First Line	:	4430 SHERIDAN ST STE A
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3546
Country	:	US
Telephone Number	:	954-966-7770
Fax Number	:	954-966-9742

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENNETH A SABACINSKI
Credential	:	DPM
Telephone Number	:	954-966-7770

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/23/2026

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