Provider Demographics
NPI:1376781542
Name:CAROLINA PODIATRY,PC
Entity Type:Organization
Organization Name:CAROLINA PODIATRY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DE MEO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-725-7030
Mailing Address - Street 1:1075 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3242
Mailing Address - Country:US
Mailing Address - Phone:914-725-7030
Mailing Address - Fax:914-725-7031
Practice Address - Street 1:1075 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3242
Practice Address - Country:US
Practice Address - Phone:914-725-7030
Practice Address - Fax:914-725-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005041213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005041-0OtherWORKERS COMP
NYP00123511OtherMEDICARE PIN
NY4200430001OtherDME
NY01578972Medicaid
NYJD0P755010OtherEMPIRE BC/BS
NYP479107OtherOXFORD
NYP75501OtherBC/BS
NYP75501Medicare PIN
NY4200430001OtherDME
NY4200430001Medicare NSC