MEDICARE: GEORGE PACE DPM LLC

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	N003966	NY

General Provider Information

NPI Number	:	1902070105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE PACE DPM LLC

Provider Business Mailing Address
First Line	:	52 DUANE ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-1207
Country	:	US
Telephone Number	:	718-330-1117
Fax Number	:	718-875-3171

Provider Business Practice Location Address
First Line	:	133 SMITH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-6204
Country	:	US
Telephone Number	:	718-330-1117
Fax Number	:	718-875-3171

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE PACE
Credential	:	DPM
Telephone Number	:	212-349-7676

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	06/20/2010

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