Provider Demographics
NPI:1265670640
Name:ASTORIA ADVANCED FOOTCARE
Entity Type:Organization
Organization Name:ASTORIA ADVANCED FOOTCARE
Other - Org Name:GRAND CENTRAL PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-545-3338
Mailing Address - Street 1:501 5TH AVE
Mailing Address - Street 2:SUITE#1108
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6107
Mailing Address - Country:US
Mailing Address - Phone:212-682-3338
Mailing Address - Fax:212-682-3335
Practice Address - Street 1:501 5TH AVE
Practice Address - Street 2:SUITE#1108
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6107
Practice Address - Country:US
Practice Address - Phone:212-682-3338
Practice Address - Fax:212-682-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004560213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU35604Medicare UPIN