MEDICARE: TRI-STATE FOOT CARE, P.C

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	N005668	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P07851	OTHER	NY	MEDICARE ID NUMBER

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	:	1972762458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE FOOT CARE, P.C

Provider Business Mailing Address
First Line	:	13 S SHORE DR
Second Line	:
City	:	SOUTH AMBOY
State	:	NJ
Zip	:	08879-3433
Country	:	US
Telephone Number	:	866-464-1065
Fax Number	:

Provider Business Practice Location Address
First Line	:	1164 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5418
Country	:	US
Telephone Number	:	866-464-1065
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VASILIOS NICHOLAS SPYROPOULOS
Credential	:
Telephone Number	:	866-464-1065

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	10/06/2008

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Directions to “TRI-STATE FOOT CARE, P.C ” Practice Location

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