Provider Demographics
NPI:1760016711
Name:NYOTA MEDICAL FOOTCARE, PLLC
Entity Type:Organization
Organization Name:NYOTA MEDICAL FOOTCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NADEGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:617-959-1347
Mailing Address - Street 1:377 WILLARD ST STE 342
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6122
Mailing Address - Country:US
Mailing Address - Phone:857-246-9393
Mailing Address - Fax:
Practice Address - Street 1:140 WOOD RD STE 305
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2514
Practice Address - Country:US
Practice Address - Phone:857-246-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric