Provider Demographics
NPI:1346789484
Name:PIDICH PODIATRY PC
Entity Type:Organization
Organization Name:PIDICH PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PIDICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-548-1104
Mailing Address - Street 1:45 W 34TH ST
Mailing Address - Street 2:SUITE 903
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3008
Mailing Address - Country:US
Mailing Address - Phone:718-548-1104
Mailing Address - Fax:718-548-1103
Practice Address - Street 1:45 W 34TH ST
Practice Address - Street 2:SUITE 903
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3008
Practice Address - Country:US
Practice Address - Phone:718-548-1104
Practice Address - Fax:718-548-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006354305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300353387Medicare UPIN