Provider Demographics
NPI:1386746816
Name:RICHMOND COUNTY PODIATRY FAM FC CENTER
Entity type:Organization
Organization Name:RICHMOND COUNTY PODIATRY FAM FC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCDONALD ASHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DPM
Authorized Official - Phone:212-523-2930
Mailing Address - Street 1:PO BOX 140334
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-0334
Mailing Address - Country:US
Mailing Address - Phone:212-523-2930
Mailing Address - Fax:770-774-0160
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-523-2930
Practice Address - Fax:770-774-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004938-1213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01285818Medicaid
NYU32611Medicare UPIN
NYP52371Medicare ID - Type Unspecified