Provider Demographics
NPI:1063509537
Name:FOOTCARE ASSOCIATES OF REGO PARK PC
Entity Type:Organization
Organization Name:FOOTCARE ASSOCIATES OF REGO PARK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-268-0885
Mailing Address - Street 1:9424 63RD DR
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2028
Mailing Address - Country:US
Mailing Address - Phone:718-268-0885
Mailing Address - Fax:
Practice Address - Street 1:9424 63RD DR
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2028
Practice Address - Country:US
Practice Address - Phone:718-268-0885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0003536213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCM4431OtherRAILROAD MEDICARE
NYT31998Medicare UPIN
NY40082Medicare PIN
NY4433040001Medicare NSC