MEDICARE: OCEAN AVENUE 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	213ES0131X	Foot Surgery Podiatrist	N005659	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	:	1629111646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN AVENUE PODIATRY PC

Provider Business Mailing Address
First Line	:	2962 OCEAN AVE
Second Line	:	UNIT 1
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3202
Country	:	US
Telephone Number	:	718-332-3003
Fax Number	:	718-332-3113

Provider Business Practice Location Address
First Line	:	2962 OCEAN AVE
Second Line	:	UNIT 1
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3202
Country	:	US
Telephone Number	:	718-332-3003
Fax Number	:	718-332-3113

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MERABI ZONENASHVILI
Credential	:	D.P.M.
Telephone Number	:	718-332-3003

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	05/15/2008

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