Provider Demographics
NPI:1710329248
Name:BROOKLYN FOOTCARE, P.C.
Entity Type:Organization
Organization Name:BROOKLYN FOOTCARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIBU
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KINATUKARA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-251-1122
Mailing Address - Street 1:1899 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5307
Mailing Address - Country:US
Mailing Address - Phone:718-251-1122
Mailing Address - Fax:718-251-1856
Practice Address - Street 1:1899 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5307
Practice Address - Country:US
Practice Address - Phone:718-251-1122
Practice Address - Fax:718-251-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005595213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty