Provider Demographics
NPI:1558534735
Name:COMPREHENSIVE FOOT AND ANKLE CARE
Entity Type:Organization
Organization Name:COMPREHENSIVE FOOT AND ANKLE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-623-5933
Mailing Address - Street 1:55 OLD NYACK TPKE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2461
Mailing Address - Country:US
Mailing Address - Phone:845-623-5933
Mailing Address - Fax:845-623-4261
Practice Address - Street 1:55 OLD NYACK TPKE
Practice Address - Street 2:SUITE 407
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2461
Practice Address - Country:US
Practice Address - Phone:845-623-5933
Practice Address - Fax:845-623-4261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004113-1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4483320001OtherDMERC
NJ4483320001Medicare NSC
4483320001OtherDMERC