Basic Information
| Provider Information | |||||||||
| NPI: | 1063696987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST TREMONT FOOT CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3635 E TREMONT AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104652010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184090400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3635 E TREMONT AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104652010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184090400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 06/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | VINCETIC | ||||||||
| AuthorizedOfficialFirstName: | ANTO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7184090400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | N004819 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.