Provider Demographics
NPI:1780616763
Name:FOOT CLINICS OF NEW YORK
Entity type:Organization
Organization Name:FOOT CLINICS OF NEW YORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STURM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-410-8047
Mailing Address - Street 1:55 E 124TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1815
Mailing Address - Country:US
Mailing Address - Phone:212-410-8100
Mailing Address - Fax:212-410-8166
Practice Address - Street 1:55 E 124TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1815
Practice Address - Country:US
Practice Address - Phone:212-410-8100
Practice Address - Fax:212-410-8166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4106160001Medicare NSC