1952362865 NPI number — FAMILY FOOTCARE GROUP LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952362865 NPI number — FAMILY FOOTCARE GROUP LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FOOTCARE GROUP LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952362865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 BROADWAY
Provider Second Line Business Mailing Address:
SUITE #2
Provider Business Mailing Address City Name:
MONTICELLO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12701-1742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-794-7741
Provider Business Mailing Address Fax Number:
845-794-0228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12701-1742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-794-7741
Provider Business Practice Location Address Fax Number:
845-794-0228
Provider Enumeration Date:
03/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ATLAS
Authorized Official First Name:
GREGG
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
PODIATRIST PARTNER
Authorized Official Telephone Number:
845-794-7741

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01948732 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0441090001 . This is a "MEDICARE DMERC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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