1093568222 NPI number — PODIATRY TREATMENT SERVICES PLLC

Table of content: (NPI 1093568222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093568222 NPI number — PODIATRY TREATMENT SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY TREATMENT SERVICES PLLC
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:
1093568222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3079 BRIGHTON 13TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11235-5607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-554-3862
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 LATTINGTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCUST VALLEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11560-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-554-3862
Provider Business Practice Location Address Fax Number:
718-554-0979
Provider Enumeration Date:
04/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
VORONOVA
Authorized Official First Name:
YELENA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
718-554-3862

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)





Copyright © 2007-2025 www.npivalidator.com