Provider Demographics
NPI:1043305980
Name:HJD DIABETIC FOOT & ANKLE CTR
Entity Type:Organization
Organization Name:HJD DIABETIC FOOT & ANKLE CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER PHYSICIANS BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:HALBER
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:212-460-0110
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:MADISON SQUARE STATOPM
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10159-0800
Mailing Address - Country:US
Mailing Address - Phone:212-460-0110
Mailing Address - Fax:212-460-0160
Practice Address - Street 1:301 E 17TH ST
Practice Address - Street 2:10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-460-0110
Practice Address - Fax:212-460-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW86811Medicare ID - Type Unspecified