MEDICARE: HIS FOOTPRINT PODIATRY

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	:	1922683697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIS FOOTPRINT PODIATRY

Provider Business Mailing Address
First Line	:	8 VILLAGE HILL DR
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 ROCKAWAY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4810
Country	:	US
Telephone Number	:	718-434-3338
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	FRANCOISE JUSMA
Credential	:
Telephone Number	:	718-434-3338

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/15/2021

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Directions to “HIS FOOTPRINT PODIATRY ” Practice Location

Language	Start Address	Practice Location

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