MEDICARE: LONGWOOD FOOT CARE, P.C.

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	213ES0131X	Foot Surgery Podiatrist	N004301	NY

General Provider Information

NPI Number	:	1437232816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONGWOOD FOOT CARE, P.C.

Provider Business Mailing Address
First Line	:	100 MIDDLE COUNTRY RD
Second Line	:
City	:	CORAM
State	:	NY
Zip	:	11727-4412
Country	:	US
Telephone Number	:	631-696-9636
Fax Number	:	631-696-9635

Provider Business Practice Location Address
First Line	:	100 MIDDLE COUNTRY RD
Second Line	:
City	:	CORAM
State	:	NY
Zip	:	11727-4412
Country	:	US
Telephone Number	:	631-696-9636
Fax Number	:	631-696-9635

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. CHRISTINE B STERN
Credential	:	D.P.M.
Telephone Number	:	631-696-9636

Provider Enumeration Date	:	10/22/2006
Last Update Date	:	06/03/2011

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