1689613598 NPI number — HEALTHDRIVE PODIATRY GROUP, PC

Table of content: (NPI 1689613598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689613598 NPI number — HEALTHDRIVE PODIATRY GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHDRIVE PODIATRY GROUP, PC
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:
6
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:
1689613598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CROSSING BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702-5555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-964-6681
Provider Business Mailing Address Fax Number:
339-686-2561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 METRO PL S STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43017-3394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-964-6681
Provider Business Practice Location Address Fax Number:
888-662-0859
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALTOMONTE
Authorized Official First Name:
RIYA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/PRACTICE DIRECTOR
Authorized Official Telephone Number:
857-255-0486

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9769536 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y77147 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 41738600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI9828 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 300034092 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 423718800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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