Provider Demographics
NPI:1891816278
Name:INNOVATIVE FOOTCARE
Entity Type:Organization
Organization Name:INNOVATIVE FOOTCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:LOCASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-292-7081
Mailing Address - Street 1:391 E 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3907
Mailing Address - Country:US
Mailing Address - Phone:718-292-7081
Mailing Address - Fax:718-292-7094
Practice Address - Street 1:111 SMITHTOWN BYP STE 103
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2512
Practice Address - Country:US
Practice Address - Phone:631-724-3338
Practice Address - Fax:631-724-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003762213E00000X
NYN004738213E00000X
NYN005916213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00873914Medicaid
NYPJ1321Medicare ID - Type Unspecified
NYU33877Medicare UPIN
NYT51215Medicare UPIN
NY00873914Medicaid
U97450Medicare UPIN
NYP55621Medicare ID - Type Unspecified