Provider Demographics
NPI:1598937914
Name:MAJAK PODIATRY, P.C.
Entity Type:Organization
Organization Name:MAJAK PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAJAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-782-4800
Mailing Address - Street 1:513 WASHINGTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4073
Mailing Address - Country:US
Mailing Address - Phone:315-782-4800
Mailing Address - Fax:
Practice Address - Street 1:513 WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-782-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003486-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0544230001Medicare NSC
NYT83172Medicare UPIN
NYAA1598Medicare PIN
NYAA1597Medicare PIN