Provider Demographics
NPI:1679765002
Name:FAMILY PODIATRY ASS.PC
Entity Type:Organization
Organization Name:FAMILY PODIATRY ASS.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LATTARULO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-345-3400
Mailing Address - Street 1:160 SOUTH CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523
Mailing Address - Country:US
Mailing Address - Phone:914-345-3400
Mailing Address - Fax:914-345-3481
Practice Address - Street 1:160 SOUTH CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523
Practice Address - Country:US
Practice Address - Phone:914-345-3400
Practice Address - Fax:914-345-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51191Medicare UPIN