MEDICARE: ALPS ROAD FAMILY FOOT AND ANKLE

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	261QP1100X	Podiatric Clinic/Center	N006293-1	NY

General Provider Information

NPI Number	:	1831628007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPS ROAD FAMILY FOOT AND ANKLE

Provider Business Mailing Address
First Line	:	1855 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3940
Country	:	US
Telephone Number	:	973-650-5270
Fax Number	:	973-832-4062

Provider Business Practice Location Address
First Line	:	2323 EASTCHESTER RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5910
Country	:	US
Telephone Number	:	973-650-5270
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. IRMA G GODOY
Credential	:	DPM
Telephone Number	:	973-650-5270

Provider Enumeration Date	:	06/09/2017
Last Update Date	:	03/17/2018

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