Provider Demographics
NPI:1265711949
Name:NYC ADVANCED FOOTCARE PC
Entity type:Organization
Organization Name:NYC ADVANCED FOOTCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-486-7333
Mailing Address - Street 1:121 E 60TH ST
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1117
Mailing Address - Country:US
Mailing Address - Phone:212-486-7333
Mailing Address - Fax:212-486-7555
Practice Address - Street 1:16215 HIGHLAND AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3452
Practice Address - Country:US
Practice Address - Phone:718-658-9383
Practice Address - Fax:718-658-9385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006375261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric