Provider Demographics
NPI:1073701710
Name:FAMILY FOOTCARE GROUP, LLP
Entity type:Organization
Organization Name:FAMILY FOOTCARE GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUDES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-794-7741
Mailing Address - Street 1:427 BROADWAY
Mailing Address - Street 2:STE 2
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1742
Mailing Address - Country:US
Mailing Address - Phone:845-794-7741
Mailing Address - Fax:845-794-0228
Practice Address - Street 1:400 STATE ROUTE 17M
Practice Address - Street 2:STE 17
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4415
Practice Address - Country:US
Practice Address - Phone:845-492-8637
Practice Address - Fax:845-794-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0441090001OtherMEDICARE DMERC
NY0441090001OtherMEDICARE DMERC