Provider Demographics
NPI:1477299410
Name:ISLAND FOOT CARE CORP
Entity Type:Organization
Organization Name:ISLAND FOOT CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SADIA
Authorized Official - Middle Name:RIZVI
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-613-1629
Mailing Address - Street 1:1578 WILLIAMSBRIDGE RD APT 3A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6268
Mailing Address - Country:US
Mailing Address - Phone:917-613-1629
Mailing Address - Fax:
Practice Address - Street 1:1441 KAPIOLANI BLVD STE 608
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4403
Practice Address - Country:US
Practice Address - Phone:917-613-1629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty