Provider Demographics
NPI:1487033700
Name:SEARS PODIATRY PC
Entity Type:Organization
Organization Name:SEARS PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:V
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-861-0250
Mailing Address - Street 1:15-01 POLLITT DR
Mailing Address - Street 2:IND CTR-UNIT 8B
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2769
Mailing Address - Country:US
Mailing Address - Phone:917-861-0250
Mailing Address - Fax:
Practice Address - Street 1:15-01 POLLITT DR
Practice Address - Street 2:IND CTR-UNIT 8B
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2769
Practice Address - Country:US
Practice Address - Phone:917-861-0250
Practice Address - Fax:201-773-6539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00325100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty