Provider Demographics
NPI:1326251026
Name:HEALTHDRIVE PODIATRY GROUP, PC
Entity Type:Organization
Organization Name:HEALTHDRIVE PODIATRY GROUP, PC
Other - Org Name:HEALTHDRIVE PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PRACTICE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTOMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:857-255-0486
Mailing Address - Street 1:100 CROSSING BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5555
Mailing Address - Country:US
Mailing Address - Phone:617-964-6681
Mailing Address - Fax:339-686-2561
Practice Address - Street 1:115 BROADWAY
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2835
Practice Address - Country:US
Practice Address - Phone:914-693-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHDRIVE PODIATRY GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-08
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1956213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01761540Medicaid
NYDN4475OtherMEDICARE RAILROAD
NY01761540Medicaid