Provider Demographics
NPI:1558532911
Name:STATEN ISLAND PODIATRY OBS,PLLC
Entity Type:Organization
Organization Name:STATEN ISLAND PODIATRY OBS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FERDINANDO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-720-6866
Mailing Address - Street 1:970 BARD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3322
Mailing Address - Country:US
Mailing Address - Phone:718-720-6866
Mailing Address - Fax:718-720-6913
Practice Address - Street 1:970 BARD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3322
Practice Address - Country:US
Practice Address - Phone:718-720-6866
Practice Address - Fax:718-720-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical