Provider Demographics
NPI:1598942757
Name:PREMIER FOOT & ANKLE PC
Entity Type:Organization
Organization Name:PREMIER FOOT & ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VASILIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMIOS-LAGUDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-225-8200
Mailing Address - Street 1:4420 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3041
Mailing Address - Country:US
Mailing Address - Phone:718-225-8200
Mailing Address - Fax:718-225-8203
Practice Address - Street 1:4420 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3041
Practice Address - Country:US
Practice Address - Phone:718-225-8200
Practice Address - Fax:718-225-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005622261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric