Provider Demographics
NPI:1760806566
Name:DRV FOOTCARE P.C.
Entity Type:Organization
Organization Name:DRV FOOTCARE P.C.
Other - Org Name:TAMIRA VANNOY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANNOY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-348-5981
Mailing Address - Street 1:1027 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:BKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208
Mailing Address - Country:US
Mailing Address - Phone:718-348-5981
Mailing Address - Fax:718-348-5139
Practice Address - Street 1:1027 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:BKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208
Practice Address - Country:US
Practice Address - Phone:718-348-5981
Practice Address - Fax:718-348-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005267213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP51751Medicare PIN
NYUP61975Medicare UPIN