MEDICARE: SUSAN AMICO D.P.M.

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	N003694	NY
2	213E00000X	Podiatrist	N003694	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457367724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN AMICO D.P.M.

Provider Business Mailing Address
First Line	:	62 SEGUINE AVE STE 2
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3723
Country	:	US
Telephone Number	:	718-317-7740
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 SEGUINE AVE STE 2
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3723
Country	:	US
Telephone Number	:	718-317-7740
Fax Number	:	718-948-1090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	02/13/2022

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