Provider Demographics
NPI:1952362865
Name:FAMILY FOOTCARE GROUP LLP
Entity Type:Organization
Organization Name:FAMILY FOOTCARE GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ATLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-794-7741
Mailing Address - Street 1:427 BROADWAY
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1742
Mailing Address - Country:US
Mailing Address - Phone:845-794-7741
Mailing Address - Fax:845-794-0228
Practice Address - Street 1:427 BROADWAY
Practice Address - Street 2:SUITE #2
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1742
Practice Address - Country:US
Practice Address - Phone:845-794-7741
Practice Address - Fax:845-794-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01948732Medicaid
NY0441090001OtherMEDICARE DMERC
NYP0W431Medicare PIN
NY01948732Medicaid