Provider Demographics
NPI:1659487205
Name:MAIN STREET FOOTCARE, PLLC
Entity Type:Organization
Organization Name:MAIN STREET FOOTCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROSENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-263-8118
Mailing Address - Street 1:6920 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1703
Mailing Address - Country:US
Mailing Address - Phone:718-263-8118
Mailing Address - Fax:718-261-4220
Practice Address - Street 1:6920 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1703
Practice Address - Country:US
Practice Address - Phone:718-263-8118
Practice Address - Fax:718-261-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005978213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty