MEDICARE: EAST COAST PODIATRIC MEDICINE AND SURGERY LLC

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	HCC6902	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356392500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COAST PODIATRIC MEDICINE AND SURGERY LLC

Provider Business Mailing Address
First Line	:	2802 AVENUE P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1810
Country	:	US
Telephone Number	:	917-370-6672
Fax Number	:	718-252-5810

Provider Business Practice Location Address
First Line	:	5401 COLLINS AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2573
Country	:	US
Telephone Number	:	917-370-6672
Fax Number	:	718-252-5810

Authorized Official
Title or Position	:	MEMBER/PRESIDENT
Name	:	ALAN TAJERSTEIN
Credential	:
Telephone Number	:	917-370-6672

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	01/10/2013

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