Provider Demographics
NPI:1003088238
Name:QUEENS CORPORATE FOOT CARE, P.C.
Entity Type:Organization
Organization Name:QUEENS CORPORATE FOOT CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-776-7232
Mailing Address - Street 1:221-10 JAMAICA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-2037
Mailing Address - Country:US
Mailing Address - Phone:718-776-7232
Mailing Address - Fax:718-776-7418
Practice Address - Street 1:221-10 JAMAICA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-2037
Practice Address - Country:US
Practice Address - Phone:718-776-7232
Practice Address - Fax:718-776-7418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005136261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016455697Medicaid
486204001OtherDME
NY1003088238Medicare NSC
NY01943Medicare PIN
NYP16401Medicare PIN