Provider Demographics
NPI:1639325517
Name:CHELSEA FOOT CARE CENTER
Entity Type:Organization
Organization Name:CHELSEA FOOT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-807-8155
Mailing Address - Street 1:405 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1404
Mailing Address - Country:US
Mailing Address - Phone:212-807-8155
Mailing Address - Fax:
Practice Address - Street 1:405 W 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1404
Practice Address - Country:US
Practice Address - Phone:212-807-8155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002961213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5175100001Medicare NSC