Provider Demographics
NPI:1174772446
Name:THE FOOT SPECIALTY PRACTICE, P.C.
Entity type:Organization
Organization Name:THE FOOT SPECIALTY PRACTICE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:MYREL
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-522-2770
Mailing Address - Street 1:903 UTICA AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4313
Mailing Address - Country:US
Mailing Address - Phone:718-493-5986
Mailing Address - Fax:646-843-4712
Practice Address - Street 1:903 UTICA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4313
Practice Address - Country:US
Practice Address - Phone:718-493-5986
Practice Address - Fax:646-843-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006209213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty