Provider Demographics
NPI:1659542769
Name:FAMILY FOOT CARE
Entity Type:Organization
Organization Name:FAMILY FOOT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PICCHIONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-758-1331
Mailing Address - Street 1:1315 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-5272
Mailing Address - Country:US
Mailing Address - Phone:518-689-5390
Mailing Address - Fax:518-689-5396
Practice Address - Street 1:1315 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5272
Practice Address - Country:US
Practice Address - Phone:518-689-5390
Practice Address - Fax:518-689-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004801213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01204764Medicaid
NYDF6656Medicare PIN
NY53793AMedicare PIN
NY01204764Medicaid