MEDICARE: HUGUENOT PODIATRY GROUP 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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1689929374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUGUENOT PODIATRY GROUP PC

Provider Business Mailing Address
First Line	:	62 SEGUINE AVE UNIT 2
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3723
Country	:	US
Telephone Number	:	718-948-3838
Fax Number	:	718-948-1090

Provider Business Practice Location Address
First Line	:	62 SEGUINE AVE UNIT 2
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3723
Country	:	US
Telephone Number	:	718-948-3838
Fax Number	:	718-948-3838

Authorized Official
Title or Position	:	PODIATRIST
Name	:	MARIANNE LANTS
Credential	:	DPM
Telephone Number	:	718-948-3838

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	05/27/2022

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