Provider Demographics
NPI:1164593695
Name:TOBACK PODIATRY, PLLC
Entity Type:Organization
Organization Name:TOBACK PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:TOBACK
Authorized Official - Suffix:
Authorized Official - Credentials:PODIATRIST
Authorized Official - Phone:845-691-3654
Mailing Address - Street 1:PO BOX 1550
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-8550
Mailing Address - Country:US
Mailing Address - Phone:845-339-3338
Mailing Address - Fax:845-340-1074
Practice Address - Street 1:3433 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-8550
Practice Address - Country:US
Practice Address - Phone:845-339-3338
Practice Address - Fax:845-340-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004154-3213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5423190001Medicare NSC
NYPXW161Medicare ID - Type Unspecified
NYT51435Medicare UPIN