MEDICARE: FUTURE PODIATRIST 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	006382	NY

General Provider Information

NPI Number	:	1336441864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUTURE PODIATRIST P.C.

Provider Business Mailing Address
First Line	:	2821 W 12TH ST APT 19D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3129
Country	:	US
Telephone Number	:	347-729-0615
Fax Number	:	347-729-0615

Provider Business Practice Location Address
First Line	:	2821 W 12TH ST APT 19D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3129
Country	:	US
Telephone Number	:	347-729-0615
Fax Number	:	347-729-0615

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERNEST TSILOV
Credential	:	D.P.M
Telephone Number	:	347-729-0615

Provider Enumeration Date	:	12/05/2010
Last Update Date	:	12/05/2010

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