Provider Demographics
NPI:1205939402
Name:EMPIRE FOOTCARE & SURGERY PC
Entity type:Organization
Organization Name:EMPIRE FOOTCARE & SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FANNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-960-4023
Mailing Address - Street 1:6406 FLEET ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5243
Mailing Address - Country:US
Mailing Address - Phone:917-960-4023
Mailing Address - Fax:212-503-3555
Practice Address - Street 1:6406 FLEET ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11374-5243
Practice Address - Country:US
Practice Address - Phone:917-960-4023
Practice Address - Fax:122-503-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0060041213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02637290Medicaid
U99181Medicare UPIN