Provider Demographics
NPI:1588217640
Name:FOOTCARE NOW PODIATRY, PLLC
Entity Type:Organization
Organization Name:FOOTCARE NOW PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-405-7881
Mailing Address - Street 1:718 BROUGHTON ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-6648
Mailing Address - Country:US
Mailing Address - Phone:803-531-2888
Mailing Address - Fax:803-531-2813
Practice Address - Street 1:3757 91ST ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7968
Practice Address - Country:US
Practice Address - Phone:917-405-7881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty