Organization Active NPI

Family Footcare and Surgery PLLC

  • Foot Surgery Podiatrist
  • Highland Mills, NY
National Provider Identifier
1780834051
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
N006232 Issued in NY
Legal business name
FAMILY FOOTCARE AND SURGERY PLLC
Practice address
29 Heather RDG
Highland Mills, NY 10930-8321
Phone
(718) 793-5511
Fax
(718) 793-5512
NPI assigned
Sep 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tetyana Boreesenko, DPMNPI 1649448879
Title
Owner
Phone
(718) 793-5511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0131X N006232 NY Primary
Podiatric Clinic/Center 261QP1100X

Addresses

Primary practice location

29 Heather RDG
Highland Mills, NY 10930-8321

Mailing address

29 Heather RDG
Highland Mills, NY 10930-8321
Phone (718) 793-5511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081121000009 NY Part B Supplier - Clinic/Group Practice 8729148754 Receives reassigned benefits from 1 practitioner
Practice locations: Highland Mills, NY

National Provider Directory

National Provider Directory

Locations

10721 Queens Blvd
Ste 11
Forest Hills, NY 11375
Phone (718) 377-7629

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1780834051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 HEATHER RDG",
            "city": "HIGHLAND MILLS",
            "state": "NY",
            "postal_code": "109308321",
            "telephone_number": "718-793-5511",
            "fax_number": "718-793-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 HEATHER RDG",
            "city": "HIGHLAND MILLS",
            "state": "NY",
            "postal_code": "109308321",
            "telephone_number": "718-793-5511",
            "fax_number": "718-793-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY FOOTCARE AND SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-23",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "BOREESENKO",
        "authorized_official_first_name": "TETYANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-793-5511",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NY",
            "license": "N006232",
            "primary": true
        },
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland Mills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.