MEDICARE: KAISER PODIATRY, PLLC

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	N005189	NY

General Provider Information

NPI Number	:	1386835759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAISER PODIATRY, PLLC

Provider Business Mailing Address
First Line	:	1335 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5655
Country	:	US
Telephone Number	:	718-375-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1335 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5655
Country	:	US
Telephone Number	:	718-375-3900
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LAURIE BLISS
Credential	:
Telephone Number	:	718-375-3900

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	07/17/2008

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