Organization
DT FOOT CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID TETROKALASHVILI DPM (PRESIDENT)
(718) 969-0269
Entity
Organization
Contact information
Practice address
9314 QUEENS BLVD, 1E, REGO PARK, NY 11374-1135
(718) 275-7600
Mailing address
7922 147TH ST, APT. E4, FLUSHING, NY 11367-3733
(718) 969-0269
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
N006091-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9541060
AETNA HMO
NY
Enumeration date
03/16/2015
Last updated
03/16/2015
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