Provider Demographics
NPI:1194856757
Name:ADVANCED FOOT CARE OF LONG ISLANCE, P.C.
Entity Type:Organization
Organization Name:ADVANCED FOOT CARE OF LONG ISLANCE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-295-0825
Mailing Address - Street 1:821 WOODMERE CT
Mailing Address - Street 2:SU 1C
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2552
Mailing Address - Country:US
Mailing Address - Phone:516-295-0825
Mailing Address - Fax:516-295-0825
Practice Address - Street 1:821 WOODMERE CT
Practice Address - Street 2:SU 1C
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2552
Practice Address - Country:US
Practice Address - Phone:516-295-0825
Practice Address - Fax:516-295-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO4792-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1042323OtherUNITED HEALTH CARE
NY59872OtherVYTRA HEALTH PLANS
NY6200506OtherGHI
NY1C6729OtherHEALTH NET
NY01302785Medicaid
NY4950990001OtherDME MEDICARE
NY9131217OtherCIGNA
NY59872OtherVYTRA HEALTH PLANS
NYPAWG21Medicare ID - Type Unspecified