MEDICARE: CARROLL GARDENS 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	213E00000X	Podiatrist	N004268	NY

General Provider Information

NPI Number	:	1225279367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARROLL GARDENS PODIATRY P.C.

Provider Business Mailing Address
First Line	:	398 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-4206
Country	:	US
Telephone Number	:	718-834-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	398 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-4206
Country	:	US
Telephone Number	:	718-834-0909
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN PACE
Credential	:	D.P.M
Telephone Number	:	718-834-0909

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	03/19/2009

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