Provider Demographics
NPI:1609375252
Name:AVENUE U PODIATRY,P.C.
Entity Type:Organization
Organization Name:AVENUE U PODIATRY,P.C.
Other - Org Name:FAMILY FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARCHESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-714-8420
Mailing Address - Street 1:3010 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2077
Mailing Address - Country:US
Mailing Address - Phone:718-890-4066
Mailing Address - Fax:718-714-6787
Practice Address - Street 1:3010 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2077
Practice Address - Country:US
Practice Address - Phone:718-890-4066
Practice Address - Fax:718-714-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies