Provider Demographics
NPI:1164547220
Name:SCOTT LURIE & DAVID ROSSMAN PTRS FOREST HILLS PODIATRIC MEDICAL
Entity Type:Organization
Organization Name:SCOTT LURIE & DAVID ROSSMAN PTRS FOREST HILLS PODIATRIC MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:LURIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-520-8811
Mailing Address - Street 1:71 11 110TH STREET
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4851
Mailing Address - Country:US
Mailing Address - Phone:718-520-8811
Mailing Address - Fax:718-520-6646
Practice Address - Street 1:71 11 110TH STREET
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4851
Practice Address - Country:US
Practice Address - Phone:718-520-8811
Practice Address - Fax:718-520-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003793213E00000X
NY003765213E00000X
NYN0057661213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24389Medicare PIN