Provider Demographics
NPI:1750779278
Name:FOOTHURT PODIATRY P.C.
Entity type:Organization
Organization Name:FOOTHURT PODIATRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-255-7234
Mailing Address - Street 1:25 W 45TH ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4902
Mailing Address - Country:US
Mailing Address - Phone:212-704-4310
Mailing Address - Fax:212-704-4311
Practice Address - Street 1:25 W 45TH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4902
Practice Address - Country:US
Practice Address - Phone:212-704-4310
Practice Address - Fax:212-704-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005136213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01645569Medicaid
NYU56910Medicare UPIN