Provider Demographics
NPI:1265730477
Name:SENIOR FOOT CARE P.C.
Entity type:Organization
Organization Name:SENIOR FOOT CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-424-3926
Mailing Address - Street 1:76 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-2108
Mailing Address - Country:US
Mailing Address - Phone:518-573-0946
Mailing Address - Fax:
Practice Address - Street 1:76 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-2108
Practice Address - Country:US
Practice Address - Phone:518-573-0946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002852213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00558961Medicaid
10000761OtherCDPHP
NY00558961Medicaid