MEDICARE: FOOTPRINTS PEDIATRIC MEDICINE, 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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1881486298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTPRINTS PEDIATRIC MEDICINE, PC

Provider Business Mailing Address
First Line	:	1023 FOREST HILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-6323
Country	:	US
Telephone Number	:	718-534-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 FOREST HILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-6323
Country	:	US
Telephone Number	:	718-534-0505
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH A DARCY
Credential	:	MD
Telephone Number	:	718-534-0505

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	05/21/2025

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