Provider Demographics
NPI:1033328844
Name:GREATER QUEENS PODIATRY
Entity Type:Organization
Organization Name:GREATER QUEENS PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGDANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-463-1515
Mailing Address - Street 1:4343 KISSENA BLVD #110
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2914
Mailing Address - Country:US
Mailing Address - Phone:718-463-1515
Mailing Address - Fax:718-886-6414
Practice Address - Street 1:4343 KISSENA BLVD #110
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2914
Practice Address - Country:US
Practice Address - Phone:718-463-1515
Practice Address - Fax:718-886-6414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004326213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01049958Medicaid
NYT32074Medicare UPIN
NY03158AMedicare PIN
NY4236510001Medicare NSC