Provider Demographics
NPI: | 1366746836 |
---|---|
Name: | EMPIRE FOOT CARE, PC |
Entity type: | Organization |
Organization Name: | EMPIRE FOOT CARE, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SCOTT |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | HAUSEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPM |
Authorized Official - Phone: | 914-632-2500 |
Mailing Address - Street 1: | 466 MAIN STREET |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW ROCHELLE |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10801 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 914-632-2500 |
Mailing Address - Fax: | 914-633-4358 |
Practice Address - Street 1: | 466 MAIN STREET |
Practice Address - Street 2: | |
Practice Address - City: | NEW ROCHELLE |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10801 |
Practice Address - Country: | US |
Practice Address - Phone: | 914-632-2500 |
Practice Address - Fax: | 914-633-4358 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-12-27 |
Last Update Date: | 2010-12-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | N004950 | 213E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Single Specialty |