Provider Demographics
NPI:1083974653
Name:PREFERRED FAMILY FOOTCARE OF LI PLLC
Entity Type:Organization
Organization Name:PREFERRED FAMILY FOOTCARE OF LI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-544-7575
Mailing Address - Street 1:38 WREN DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2722
Mailing Address - Country:US
Mailing Address - Phone:516-621-4395
Mailing Address - Fax:718-544-7132
Practice Address - Street 1:38 WREN DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2722
Practice Address - Country:US
Practice Address - Phone:516-621-4395
Practice Address - Fax:718-544-7132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty