Provider Demographics
NPI:1114978038
Name:CAPITAL REGION FOOT CARE PLLC
Entity Type:Organization
Organization Name:CAPITAL REGION FOOT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:GINSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-465-3515
Mailing Address - Street 1:104 HACKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1525
Mailing Address - Country:US
Mailing Address - Phone:518-465-3515
Mailing Address - Fax:518-465-9859
Practice Address - Street 1:104 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1525
Practice Address - Country:US
Practice Address - Phone:518-465-3515
Practice Address - Fax:518-465-9859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3861213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00873872Medicaid
AA0358Medicare ID - Type Unspecified
NY0884640001Medicare NSC
NY00873872Medicaid