Provider Demographics
NPI:1922122381
Name:DELLACORTE FOOTCARE, PC
Entity Type:Organization
Organization Name:DELLACORTE FOOTCARE, PC
Other - Org Name:DELLACORTE FOOTCARE, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF PODIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DELLACORTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-639-3338
Mailing Address - Street 1:5901 69TH ST
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2946
Mailing Address - Country:US
Mailing Address - Phone:718-639-3338
Mailing Address - Fax:718-639-5184
Practice Address - Street 1:5901 69TH ST
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2946
Practice Address - Country:US
Practice Address - Phone:718-639-3338
Practice Address - Fax:718-639-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0033007213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00708723Medicaid
NYT32162Medicare UPIN
NY00708723Medicaid
NY06126Medicare ID - Type Unspecified