Provider Demographics
NPI:1669757571
Name:UNIVERSITY FOOT AND ANKLE PC
Entity type:Organization
Organization Name:UNIVERSITY FOOT AND ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARTOL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-649-4700
Mailing Address - Street 1:5 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:LLOYD HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1732
Mailing Address - Country:US
Mailing Address - Phone:914-649-4700
Mailing Address - Fax:
Practice Address - Street 1:5 CRANE ROAD
Practice Address - Street 2:
Practice Address - City:LLOYD HARBOUR
Practice Address - State:NY
Practice Address - Zip Code:11743-6691
Practice Address - Country:US
Practice Address - Phone:914-649-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005788320700000X
NY005788261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities