Provider Demographics
NPI:1033245832
Name:PODIATRIC AND SURGICAL WELLCARE OF NEW YORK PC
Entity Type:Organization
Organization Name:PODIATRIC AND SURGICAL WELLCARE OF NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:TARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-729-3653
Mailing Address - Street 1:295 WOODHOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-0719
Mailing Address - Country:US
Mailing Address - Phone:516-729-3653
Mailing Address - Fax:631-446-4122
Practice Address - Street 1:295 WOODHOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:GREAT RIVER
Practice Address - State:NY
Practice Address - Zip Code:11739-0719
Practice Address - Country:US
Practice Address - Phone:516-729-3653
Practice Address - Fax:631-446-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006025213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1033Medicare PIN
NYW7P891Medicare PIN