Provider Demographics
NPI:1083029300
Name:HOWARD BEACH PODIATRY PC
Entity Type:Organization
Organization Name:HOWARD BEACH PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-845-0741
Mailing Address - Street 1:15905 92ND ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3123
Mailing Address - Country:US
Mailing Address - Phone:718-845-0741
Mailing Address - Fax:718-835-1453
Practice Address - Street 1:15905 92ND ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3123
Practice Address - Country:US
Practice Address - Phone:718-845-0741
Practice Address - Fax:718-835-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006254261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric