MEDICARE: HAPPY & HEALTHY FEET 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	213ES0103X	Foot & Ankle Surgery Podiatrist	006443	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A300070879	OTHER	NY	MEDICARE DOWNSTATE

General Provider Information

NPI Number	:	1427304971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY & HEALTHY FEET PC

Provider Business Mailing Address
First Line	:	57 HARRISON ST
Second Line	:
City	:	HAWORTH
State	:	NJ
Zip	:	07641-1920
Country	:	US
Telephone Number	:	718-934-2211
Fax Number	:	718-934-2225

Provider Business Practice Location Address
First Line	:	665 OCEAN PKWY
Second Line	:	#2F
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1195
Country	:	US
Telephone Number	:	718-934-2211
Fax Number	:	718-934-2225

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ILVIRA ISYANOVA
Credential	:	DPM
Telephone Number	:	917-620-9187

Provider Enumeration Date	:	08/01/2012
Last Update Date	:	08/01/2012

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Directions to “HAPPY & HEALTHY FEET PC ” Practice Location

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