Provider Demographics
NPI:1366473332
Name:COMPREHENSIVE FAMILY FOOT CARE PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE FAMILY FOOT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-798-9411
Mailing Address - Street 1:658 E 233RD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2802
Mailing Address - Country:US
Mailing Address - Phone:718-798-9411
Mailing Address - Fax:718-798-9409
Practice Address - Street 1:658 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2802
Practice Address - Country:US
Practice Address - Phone:718-798-9411
Practice Address - Fax:718-798-9409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005671213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPKW851Medicare ID - Type Unspecified
CTC03117Medicare PIN
CJ3838Medicare PIN
NY4415740002Medicare NSC