Provider Demographics
NPI:1558784280
Name:GREAT STRIDES PODIATRY, P.C.
Entity Type:Organization
Organization Name:GREAT STRIDES PODIATRY, P.C.
Other - Org Name:FOREST HILLS PODIATRIC MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEKEISHA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-593-4771
Mailing Address - Street 1:7111 110TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4851
Mailing Address - Country:US
Mailing Address - Phone:718-520-8811
Mailing Address - Fax:718-520-6646
Practice Address - Street 1:7111 110TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4851
Practice Address - Country:US
Practice Address - Phone:718-520-8811
Practice Address - Fax:718-520-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006236213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty