Provider Demographics
NPI:1275710626
Name:PLAZA FOOT CARE OF MT SINAI, P.C.
Entity Type:Organization
Organization Name:PLAZA FOOT CARE OF MT SINAI, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPERLING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-647-6686
Mailing Address - Street 1:9621 BERGAMO ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6168
Mailing Address - Country:US
Mailing Address - Phone:516-647-6686
Mailing Address - Fax:561-469-2823
Practice Address - Street 1:9621 BERGAMO ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6168
Practice Address - Country:US
Practice Address - Phone:516-647-6686
Practice Address - Fax:561-469-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004169-1261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6054140001Medicare NSC
NYP43691Medicare PIN