Provider Demographics
NPI:1033586797
Name:MIDTOWN WEST PODIATRY PC
Entity Type:Organization
Organization Name:MIDTOWN WEST PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VITO
Authorized Official - Middle Name:
Authorized Official - Last Name:LA PUMA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-757-9361
Mailing Address - Street 1:16116 86TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3327
Mailing Address - Country:US
Mailing Address - Phone:212-661-3300
Mailing Address - Fax:
Practice Address - Street 1:2 W 45TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4212
Practice Address - Country:US
Practice Address - Phone:212-661-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006338213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty