Organization
SHADOW PODIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL BASALELY DPM (DOCTOR OF PODIATRIC MEDICINE)
(646) 551-6663
Entity
Organization
Contact information
Practice address
26 BROADWAY, NEW YORK, NY 10004-1703
(646) 551-6663
Mailing address
14431 70TH RD, FLUSHING, NY 11367-1717
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
006679
NY
Other
Enumeration date
09/03/2015
Last updated
09/03/2015
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