Provider Demographics
NPI:1437327418
Name:COMPREHENSIVE PODIATRY SERVICES, PC
Entity Type:Organization
Organization Name:COMPREHENSIVE PODIATRY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:LISWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-745-0256
Mailing Address - Street 1:7212 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2552
Mailing Address - Country:US
Mailing Address - Phone:718-745-0256
Mailing Address - Fax:718-833-0505
Practice Address - Street 1:7212 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2552
Practice Address - Country:US
Practice Address - Phone:718-745-0256
Practice Address - Fax:718-833-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4267710001Medicare NSC