Provider Demographics
NPI:1497773642
Name:FOOT CLINICS OF NEW YORK
Entity Type:Organization
Organization Name:FOOT CLINICS OF NEW YORK
Other - Org Name:NY COLLEGE OF PODIATRIC MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-410-8047
Mailing Address - Street 1:55 E 124TH ST
Mailing Address - Street 2:ATTN: CLINIC ADMINISTRATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1815
Mailing Address - Country:US
Mailing Address - Phone:212-410-8186
Mailing Address - Fax:212-410-8166
Practice Address - Street 1:55 E 124TH ST
Practice Address - Street 2:ATTN: CLINIC ADMINISTRATION
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1815
Practice Address - Country:US
Practice Address - Phone:212-410-8186
Practice Address - Fax:212-410-8166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219975-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH35660Medicare UPIN
NY048A9610Medicare ID - Type Unspecified