Provider Demographics
NPI:1831338649
Name:NORTH BELLMORE FOTCARE P.C
Entity type:Organization
Organization Name:NORTH BELLMORE FOTCARE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-804-2291
Mailing Address - Street 1:2348 KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3038
Mailing Address - Country:US
Mailing Address - Phone:516-804-2291
Mailing Address - Fax:516-826-5821
Practice Address - Street 1:2428 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5745
Practice Address - Country:US
Practice Address - Phone:516-804-2291
Practice Address - Fax:516-826-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004890213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN004890Medicaid
NYN004890Medicaid