Provider Demographics
NPI:1417980459
Name:PERSONALIZED FOOTCARE PC
Entity Type:Organization
Organization Name:PERSONALIZED FOOTCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AVRAHAM
Authorized Official - Middle Name:YITZCHAK
Authorized Official - Last Name:CIMENT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:646-496-8853
Mailing Address - Street 1:333 OAKFORD ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3220
Mailing Address - Country:US
Mailing Address - Phone:516-485-3021
Mailing Address - Fax:
Practice Address - Street 1:970 N BROADWAY
Practice Address - Street 2:308B
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1309
Practice Address - Country:US
Practice Address - Phone:914-423-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005916213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWTW521/PJ1321Medicare PIN