MEDICARE: DR. IDIT R FORKOSH 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	213ES0131X	Foot Surgery Podiatrist	N005510	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4C1212	OTHER	NY	HEALTHNET
2	6299196	OTHER	NY	GHI
3	5425584	OTHER	NY	BCE EMERGIS (UP &UP)
4	FI5510	OTHER		ATLANTIS
5	P05510-4W	OTHER	NY	WORKER'S COMP
6	163211	OTHER	NY	ELDERPLAN
7	N005510	OTHER	NY	MAGNACARE
8	1892417	OTHER	NY	FIRST HEALTH PINS
9	HIP	OTHER	NY	N005510
10	N005510	OTHER	NY	HORIZON HEALTHCARE
11	PB5341	OTHER	NY	BLUE CHOICE
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	N005510	OTHER	NY	1199 PCS
14	030005510NY01	OTHER	NY	ANTHEM
15	N005510	OTHER	NY	HEALTHFIRST
16	N005510	OTHER	NY	CAREPLUS
17	P2171265	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1245335108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IDIT R FORKOSH DPM

Provider Business Mailing Address
First Line	:	3600 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5237
Country	:	US
Telephone Number	:	718-758-9150
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5237
Country	:	US
Telephone Number	:	718-758-9150
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/09/2007

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