MEDICARE: PODCARE

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P5059-1	OTHER	NY	MEDICARE PROVIDER ID #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972745198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODCARE

Provider Business Mailing Address
First Line	:	1335 54TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4220
Country	:	US
Telephone Number	:	718-972-5000
Fax Number	:	718-972-3774

Provider Business Practice Location Address
First Line	:	2802 AVENUE P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1810
Country	:	US
Telephone Number	:	718-252-5590
Fax Number	:	718-972-3774

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALAN TAJERSTEIN
Credential	:	D.P.M.
Telephone Number	:	718-972-5000

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	04/02/2009

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Directions to “PODCARE ” Practice Location

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