Provider Demographics
NPI:1336323807
Name:SEA BREEZE PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:SEA BREEZE PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:VASTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-332-3020
Mailing Address - Street 1:3043 OCEAN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3400
Mailing Address - Country:US
Mailing Address - Phone:718-332-3020
Mailing Address - Fax:
Practice Address - Street 1:3043 OCEAN AVE STE 106
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3400
Practice Address - Country:US
Practice Address - Phone:718-332-3020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006152213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty