Provider Demographics
NPI:1346450459
Name:BERKELEY FOOT SPECIALISTS
Entity Type:Organization
Organization Name:BERKELEY FOOT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-526-1335
Mailing Address - Street 1:1178 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2245
Mailing Address - Country:US
Mailing Address - Phone:510-526-1335
Mailing Address - Fax:510-526-4419
Practice Address - Street 1:1178 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94706-2245
Practice Address - Country:US
Practice Address - Phone:510-526-1335
Practice Address - Fax:510-526-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2611213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629153788OtherNPI
CAT11401Medicare UPIN