MEDICARE: DR. LINCOLN ESMAY PAGE DPM

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	213E00000X	Podiatrist	N002619-1	NY

General Provider Information

NPI Number	:	1134121882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINCOLN ESMAY PAGE DPM

Provider Business Mailing Address
First Line	:	139 MAXWELL RD
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-5123
Country	:	US
Telephone Number	:	518-783-7668
Fax Number	:	518-783-7668

Provider Business Practice Location Address
First Line	:	221 JEFFERSON HTS
Second Line	:
City	:	CATSKILL
State	:	NY
Zip	:	12414-2111
Country	:	US
Telephone Number	:	518-943-4642
Fax Number	:	518-943-4642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	01/21/2014

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