Provider Demographics
NPI:1114243201
Name:ADVANCED PODIATRIC FOOTCARE
Entity Type:Organization
Organization Name:ADVANCED PODIATRIC FOOTCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCREPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-685-6441
Mailing Address - Street 1:218-84 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2166
Mailing Address - Country:US
Mailing Address - Phone:718-736-6162
Mailing Address - Fax:718-468-2047
Practice Address - Street 1:21884 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2166
Practice Address - Country:US
Practice Address - Phone:718-736-6162
Practice Address - Fax:718-468-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric