MEDICARE: DR. JOSEPH ALLAN LARSEN 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	213ES0103X	Foot & Ankle Surgery Podiatrist	N005321	NY

General Provider Information

NPI Number	:	1629193941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ALLAN LARSEN D.P.M

Provider Business Mailing Address
First Line	:	2419 JERICHO TPKE
Second Line	:
City	:	GARDEN CITY PARK
State	:	NY
Zip	:	11040-4710
Country	:	US
Telephone Number	:	516-294-9540
Fax Number	:	516-294-4119

Provider Business Practice Location Address
First Line	:	2419 JERICHO TPKE
Second Line	:
City	:	GARDEN CITY PARK
State	:	NY
Zip	:	11040-4710
Country	:	US
Telephone Number	:	516-294-9540
Fax Number	:	516-294-4119

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	03/24/2009

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