Provider Demographics
NPI:1093846081
Name:150 STREET CORP.
Entity Type:Organization
Organization Name:150 STREET CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:ZAWADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-767-4100
Mailing Address - Street 1:1257 150TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1752
Mailing Address - Country:US
Mailing Address - Phone:718-767-4100
Mailing Address - Fax:718-767-5353
Practice Address - Street 1:1257 150TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1752
Practice Address - Country:US
Practice Address - Phone:718-767-4100
Practice Address - Fax:718-767-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty