MEDICARE: COMPREHENSIVE PODIATRY SERVICES, 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	213ES0131X	Foot Surgery Podiatrist

General Provider Information

NPI Number	:	1437327418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE PODIATRY SERVICES, PC

Provider Business Mailing Address
First Line	:	7212 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2552
Country	:	US
Telephone Number	:	718-745-0256
Fax Number	:	718-833-0505

Provider Business Practice Location Address
First Line	:	7212 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2552
Country	:	US
Telephone Number	:	718-745-0256
Fax Number	:	718-833-0505

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL JASON LISWOOD
Credential	:	DPM
Telephone Number	:	718-745-0256

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/13/2008

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