Provider Demographics
NPI:1881486298
Name:FOOTPRINTS PEDIATRIC MEDICINE, PC
Entity type:Organization
Organization Name:FOOTPRINTS PEDIATRIC MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DARCY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-534-0505
Mailing Address - Street 1:1023 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6323
Mailing Address - Country:US
Mailing Address - Phone:718-534-0505
Mailing Address - Fax:
Practice Address - Street 1:1023 FOREST HILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6323
Practice Address - Country:US
Practice Address - Phone:718-534-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty