Provider Demographics
NPI:1205021128
Name:BRUMMER SURGICAL PODIATRY PC
Entity Type:Organization
Organization Name:BRUMMER SURGICAL PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-758-3939
Mailing Address - Street 1:515 MADISON AVE
Mailing Address - Street 2:1720
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5403
Mailing Address - Country:US
Mailing Address - Phone:212-758-3939
Mailing Address - Fax:212-758-4244
Practice Address - Street 1:515 MADISON AVE
Practice Address - Street 2:1720
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5403
Practice Address - Country:US
Practice Address - Phone:212-758-3939
Practice Address - Fax:212-758-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005577213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty