Provider Demographics
NPI:1376699454
Name:BAY PARKWAY PODIATRY GROUP PC
Entity Type:Organization
Organization Name:BAY PARKWAY PODIATRY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-236-7520
Mailing Address - Street 1:7902 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1965
Mailing Address - Country:US
Mailing Address - Phone:718-236-7520
Mailing Address - Fax:718-236-4250
Practice Address - Street 1:7902 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1965
Practice Address - Country:US
Practice Address - Phone:718-236-7520
Practice Address - Fax:718-236-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP57871Medicare PIN
NY4073330001Medicare NSC