Provider Demographics
NPI:1043531767
Name:MANHEIM FAMILY FOOT CARE LLC
Entity type:Organization
Organization Name:MANHEIM FAMILY FOOT CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-989-7100
Mailing Address - Street 1:6361 99TH ST
Mailing Address - Street 2:SUITE G1
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2409
Mailing Address - Country:US
Mailing Address - Phone:718-989-7100
Mailing Address - Fax:718-989-7101
Practice Address - Street 1:6361 99TH ST
Practice Address - Street 2:SUITE G1
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2409
Practice Address - Country:US
Practice Address - Phone:718-989-7100
Practice Address - Fax:718-989-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0058281213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100012808Medicare PIN
NY6389600001Medicare NSC