Provider Demographics
NPI:1497851331
Name:PLAZA PODIATRY ASSOCIATES PA
Entity Type:Organization
Organization Name:PLAZA PODIATRY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:TOBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-979-9795
Mailing Address - Street 1:5432 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3453
Mailing Address - Country:US
Mailing Address - Phone:954-979-9795
Mailing Address - Fax:954-979-1926
Practice Address - Street 1:5432 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33073-3453
Practice Address - Country:US
Practice Address - Phone:954-979-9795
Practice Address - Fax:954-979-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1842213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87978OtherBLUE SHIELD
FL480008139Medicare PIN
FLAH878Medicare PIN
FL5682040001Medicare NSC