Provider Demographics
NPI:1902017304
Name:FAMILY FOOT CARE OF NEW ROCHELLE PC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE OF NEW ROCHELLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-632-2500
Mailing Address - Street 1:466 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-632-2500
Mailing Address - Fax:914-633-4358
Practice Address - Street 1:466 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-632-2500
Practice Address - Fax:914-633-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004950213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01466637Medicaid
U42996Medicare UPIN
NYPMW321Medicare ID - Type Unspecified
5021000001Medicare NSC