Provider Demographics
NPI:1588015770
Name:E & E PODIATRY FOOT CARE PC
Entity Type:Organization
Organization Name:E & E PODIATRY FOOT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODZHAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:347-622-2804
Mailing Address - Street 1:700 W 192ND ST
Mailing Address - Street 2:APT 606
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-2517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:87 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2703
Practice Address - Country:US
Practice Address - Phone:347-850-4550
Practice Address - Fax:877-782-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty