# SHADOW PODIATRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396113692
- **Authorized official:** DR. DANIEL BASALELY DPM (DOCTOR OF PODIATRIC MEDICINE)
- **Authorized official phone:** (646) 551-6663

## Contact information

- **Practice address:** 26 BROADWAY, NEW YORK, NY 10004-1703
- **Practice address phone:** (646) 551-6663
- **Mailing address:** 14431 70TH RD, FLUSHING, NY 11367-1717

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 006679 | NY | Yes |

## Other

- **Enumeration date:** 09/03/2015
- **Last updated:** 09/03/2015