Provider Demographics
NPI:1275128126
Name:CROSS COUNTY PODIATRY, PC
Entity Type:Organization
Organization Name:CROSS COUNTY PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMANDAROV
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-440-9562
Mailing Address - Street 1:3116 30TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1545
Mailing Address - Country:US
Mailing Address - Phone:718-626-3338
Mailing Address - Fax:
Practice Address - Street 1:25062 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-4004
Practice Address - Country:US
Practice Address - Phone:646-535-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty