Provider Demographics
NPI:1508923996
Name:PACE, GEORGE (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:PACE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 5TH AVE
Mailing Address - Street 2:1110
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5010
Mailing Address - Country:US
Mailing Address - Phone:212-629-5090
Mailing Address - Fax:
Practice Address - Street 1:347 5TH AVE
Practice Address - Street 2:1110
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5010
Practice Address - Country:US
Practice Address - Phone:212-629-5090
Practice Address - Fax:212-629-5118
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003966213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY36808POtherHIP
NYP41053OtherBC BS
NY1C0178OtherHEALTHNET
NYNS772OtherOXFORD
NYNS772OtherOXFORD
NYT51269Medicare UPIN
NY1C0178OtherHEALTHNET