Provider Demographics
NPI:1316315377
Name:FOOTSTEPS PODIATRY PLLC
Entity type:Organization
Organization Name:FOOTSTEPS PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVYDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-896-2323
Mailing Address - Street 1:6743 BOOTH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2751
Mailing Address - Country:US
Mailing Address - Phone:718-896-2323
Mailing Address - Fax:718-896-2322
Practice Address - Street 1:6743 BOOTH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2751
Practice Address - Country:US
Practice Address - Phone:718-896-2323
Practice Address - Fax:718-896-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006578261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric