MEDICARE: NEW YORK FOOT CARE SERVICES 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	213ES0103X	Foot & Ankle Surgery Podiatrist	N004819-1	NY

General Provider Information

NPI Number	:	1750427928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK FOOT CARE SERVICES PLLC

Provider Business Mailing Address
First Line	:	3201 GRAND CONCOURSE APT 1N
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-1226
Country	:	US
Telephone Number	:	718-365-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 GRAND CONCOURSE APT 1N
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-1226
Country	:	US
Telephone Number	:	718-365-6363
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN A DEBELLO
Credential	:	DPM
Telephone Number	:	718-365-6363

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	12/18/2007

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