Provider Demographics
NPI:1710351242
Name:GENERAL PODIATRIC CARE LLC
Entity Type:Organization
Organization Name:GENERAL PODIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-720-8372
Mailing Address - Street 1:10 PUTTERS CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3364
Mailing Address - Country:US
Mailing Address - Phone:718-720-8372
Mailing Address - Fax:718-720-1304
Practice Address - Street 1:198 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3073
Practice Address - Country:US
Practice Address - Phone:732-617-9999
Practice Address - Fax:718-720-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD0024540213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100032983Medicare PIN
NJ231248Medicare PIN