Provider Demographics
NPI:1134671167
Name:PROGRESSIVE PODIATRY AND FOOT SURGERY
Entity Type:Organization
Organization Name:PROGRESSIVE PODIATRY AND FOOT SURGERY
Other - Org Name:PROGRESSIVE FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHROOZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDANIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-244-7670
Mailing Address - Street 1:19 W 34TH ST
Mailing Address - Street 2:SUITE 608
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3006
Mailing Address - Country:US
Mailing Address - Phone:212-244-7670
Mailing Address - Fax:212-244-3174
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:SUITE 608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:212-244-7670
Practice Address - Fax:212-244-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005601213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty