# MA PODIATRY PLLC

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

## Provider details

- **NPI number:** 1538767850
- **Authorized official:** JOHN EDWARD (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (646) 639-5291

## Contact information

- **Practice address:** 970 N BROADWAY STE 206, YONKERS, NY 10701-1310
- **Practice address phone:** (646) 639-5291
- **Practice address fax:** (914) 664-2873
- **Mailing address:** 3950 60TH ST APT A35, WOODSIDE, NY 11377-3421

## Taxonomy

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

## Other

- **Enumeration date:** 10/09/2020
- **Last updated:** 01/15/2021