Provider Demographics
NPI:1104048529
Name:ARTHUR AVE. FOOTCARE P.C.
Entity type:Organization
Organization Name:ARTHUR AVE. FOOTCARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:347-621-0251
Mailing Address - Street 1:2371 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458
Mailing Address - Country:US
Mailing Address - Phone:347-621-0251
Mailing Address - Fax:347-621-0263
Practice Address - Street 1:2371 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:347-621-0251
Practice Address - Fax:347-621-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003928213ES0103X
NYN004204213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01200504Medicaid
NYT51321Medicare UPIN
NYP44501Medicare ID - Type UnspecifiedFB
NMT81566Medicare UPIN
NYP42682Medicare ID - Type UnspecifiedVG