Provider Demographics
NPI:1568640357
Name:FARMINGDALE PODIATRY ASSOC.
Entity Type:Organization
Organization Name:FARMINGDALE PODIATRY ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-420-4031
Mailing Address - Street 1:308 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3507
Mailing Address - Country:US
Mailing Address - Phone:516-420-4031
Mailing Address - Fax:516-420-4032
Practice Address - Street 1:308 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3507
Practice Address - Country:US
Practice Address - Phone:516-420-4031
Practice Address - Fax:516-420-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4616230001Medicare NSC