Provider Demographics
NPI:1225018641
Name:WESTBURY PODIATRY PC
Entity Type:Organization
Organization Name:WESTBURY PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-333-6800
Mailing Address - Street 1:210 FULTON ST
Mailing Address - Street 2:WESTBURY PODIATRY PC
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3004
Mailing Address - Country:US
Mailing Address - Phone:516-333-6800
Mailing Address - Fax:516-333-6847
Practice Address - Street 1:210 FULTON ST
Practice Address - Street 2:WESTBURY PODIATRY PC
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3004
Practice Address - Country:US
Practice Address - Phone:516-333-6800
Practice Address - Fax:516-333-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty