Provider Demographics
NPI:1508914193
Name:GRAMERCY PARK PODIATRY, PLLC
Entity Type:Organization
Organization Name:GRAMERCY PARK PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BETSCHART
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-995-1500
Mailing Address - Street 1:380 2ND AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5615
Mailing Address - Country:US
Mailing Address - Phone:212-995-1500
Mailing Address - Fax:212-473-8563
Practice Address - Street 1:380 2ND AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5615
Practice Address - Country:US
Practice Address - Phone:212-995-1500
Practice Address - Fax:212-473-8563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005002213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5645570001Medicare NSC