Provider Demographics
NPI:1306018783
Name:NORTH SHORE PODIATRY, PC
Entity Type:Organization
Organization Name:NORTH SHORE PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-365-5544
Mailing Address - Street 1:535 PLANDOME RD
Mailing Address - Street 2:DOOR 2
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11003
Mailing Address - Country:US
Mailing Address - Phone:516-365-5544
Mailing Address - Fax:516-365-5545
Practice Address - Street 1:535 PLANDOME RD
Practice Address - Street 2:DOOR 2
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11003
Practice Address - Country:US
Practice Address - Phone:516-365-5544
Practice Address - Fax:516-365-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005323213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01774249Medicaid
NY01774249Medicaid
NY02478Medicare PIN
NY6141060001Medicare NSC