MEDICARE: BOLTROPE PODIATRY NY PLLC

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	213E00000X	Podiatrist
2	332BC3200X	Customized Equipment (DME)

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	:	1629774922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOLTROPE PODIATRY NY PLLC

Provider Business Mailing Address
First Line	:	74 PASCACK RD STE 6
Second Line	:
City	:	PARK RIDGE
State	:	NJ
Zip	:	07656-1942
Country	:	US
Telephone Number	:	201-571-0214
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 SMITH ST STE 204
Second Line	:
City	:	NANUET
State	:	NY
Zip	:	10954-2971
Country	:	US
Telephone Number	:	845-623-5863
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JEFFREY B GEWIRTZ
Credential	:	DPM
Telephone Number	:	201-391-1113

Provider Enumeration Date	:	02/07/2023
Last Update Date	:	06/10/2025

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