MEDICARE: PLAZA FOOT CARE OF MT SINAI, 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	261QP1100X	Podiatric Clinic/Center	N004169-1	NY

General Provider Information

NPI Number	:	1275710626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA FOOT CARE OF MT SINAI, P.C.

Provider Business Mailing Address
First Line	:	9621 BERGAMO ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-6168
Country	:	US
Telephone Number	:	516-647-6686
Fax Number	:	561-469-2823

Provider Business Practice Location Address
First Line	:	9621 BERGAMO ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-6168
Country	:	US
Telephone Number	:	516-647-6686
Fax Number	:	561-469-2823

Authorized Official
Title or Position	:	PPRESIDENT
Name	:	DR. EDWARD J SPERLING
Credential	:	DPM
Telephone Number	:	516-647-6686

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	12/22/2015

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