| NPI | 1619595659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK MERCER Credentialing Executive 718-841-7318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2021-04-13 |