Provider Demographics
NPI:1508082223
Name:NORTHTOWN PODIATRY GROUP PC
Entity Type:Organization
Organization Name:NORTHTOWN PODIATRY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-759-2004
Mailing Address - Street 1:9600 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2002
Mailing Address - Country:US
Mailing Address - Phone:716-759-2004
Mailing Address - Fax:716-759-2009
Practice Address - Street 1:9600 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-2002
Practice Address - Country:US
Practice Address - Phone:716-759-2004
Practice Address - Fax:716-759-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0988630001Medicare NSC