Provider Demographics
NPI:1750427928
Name:NEW YORK FOOT CARE SERVICES PLLC
Entity type:Organization
Organization Name:NEW YORK FOOT CARE SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEBELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-365-6363
Mailing Address - Street 1:3201 GRAND CONCOURSE APT 1N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1226
Mailing Address - Country:US
Mailing Address - Phone:718-365-6363
Mailing Address - Fax:
Practice Address - Street 1:3201 GRAND CONCOURSE APT 1N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1226
Practice Address - Country:US
Practice Address - Phone:718-365-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004819-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY0PPWZ710Medicare PIN
NY0742880001Medicare NSC