MEDICARE: MAMARONECK FOOT CARE

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	N003565-1	NY

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	:	1386729564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAMARONECK FOOT CARE

Provider Business Mailing Address
First Line	:	1600 HARRISON AVE
Second Line	:	SUITE 206
City	:	MAMARONECK
State	:	NY
Zip	:	10543-3145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 HARRISON AVE
Second Line	:	SUITE 206
City	:	MAMARONECK
State	:	NY
Zip	:	10543-3145
Country	:	US
Telephone Number	:	914-698-2025
Fax Number	:	914-698-1276

Authorized Official
Title or Position	:	OWNER
Name	:	LAWRENCE HANDLER
Credential	:
Telephone Number	:	914-698-2025

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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Directions to “MAMARONECK FOOT CARE ” Practice Location

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