Provider Demographics
NPI:1376605758
Name:FAMILY FOOT CARE PLLC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:PICCHIONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-758-1331
Mailing Address - Street 1:6 MAPLE LN S
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-4827
Mailing Address - Country:US
Mailing Address - Phone:518-758-1331
Mailing Address - Fax:518-758-1394
Practice Address - Street 1:6 MAPLE LN S
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-4827
Practice Address - Country:US
Practice Address - Phone:518-758-1331
Practice Address - Fax:518-758-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01204764Medicaid
NY04269132Medicaid
NY01700072Medicaid