1962795211 NPI number — THROGS NECK PODIATRY, P.C.

Table of content: DR. VICTOR M. LIZARDO M.D. (NPI 1518162080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962795211 NPI number — THROGS NECK PODIATRY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THROGS NECK PODIATRY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962795211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 VERNON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCARSDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10583-6150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 VERNON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCARSDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10583-6150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-645-6679
Provider Business Practice Location Address Fax Number:
914-472-5820
Provider Enumeration Date:
05/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GRAMUGLIA
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-645-6679

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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