Provider Demographics
NPI:1528196177
Name:CENTRAL PARK FOOT REHASBILITATION ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL PARK FOOT REHASBILITATION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:G
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-337-4900
Mailing Address - Street 1:2172 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1826
Mailing Address - Country:US
Mailing Address - Phone:914-337-4900
Mailing Address - Fax:914-337-5228
Practice Address - Street 1:2172 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1826
Practice Address - Country:US
Practice Address - Phone:914-337-4900
Practice Address - Fax:914-337-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004733213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP5W381Medicare PIN