MEDICARE: MAIDEN LANE PODIATRY, PC

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	N003415	NY

General Provider Information

NPI Number	:	1396012258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAIDEN LANE PODIATRY, PC

Provider Business Mailing Address
First Line	:	1 MAIDEN LN
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-4015
Country	:	US
Telephone Number	:	212-608-7999
Fax Number	:	212-812-3258

Provider Business Practice Location Address
First Line	:	1 MAIDEN LN
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-4015
Country	:	US
Telephone Number	:	212-608-7999
Fax Number	:	212-812-3258

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JEROME BENJAMIN LEFF
Credential	:	DPM
Telephone Number	:	212-608-7999

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	08/09/2016

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