Provider Demographics
NPI:1194380444
Name:NEW YORK PODIATRY SUITE
Entity Type:Organization
Organization Name:NEW YORK PODIATRY SUITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:VITO
Authorized Official - Middle Name:
Authorized Official - Last Name:LA PUMA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-757-9361
Mailing Address - Street 1:111 JOHN ST RM 1450
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-3122
Mailing Address - Country:US
Mailing Address - Phone:212-791-5700
Mailing Address - Fax:212-791-5704
Practice Address - Street 1:111 JOHN ST RM 1450
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3122
Practice Address - Country:US
Practice Address - Phone:212-791-5700
Practice Address - Fax:212-791-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty