Basic Information
| Provider Information | |||||||||
| NPI: | 1568710309 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPEDIC FOOT AND ANKLE CONSULTANT PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6836 | ||||||||
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| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148516836 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1534 VICTORY BLVD | ||||||||
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| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103143548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189873338 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2012 | ||||||||
| LastUpdateDate: | 11/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | CHAPMAN | ||||||||
| AuthorizedOfficialFirstName: | CARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7189873338 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0004X | 221798-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
No ID Information.