Provider Demographics
NPI:1609937648
Name:GREAT NECK PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:GREAT NECK PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:I
Authorized Official - Last Name:GREIFF
Authorized Official - Suffix:II
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-829-1028
Mailing Address - Street 1:29 BARSTOW RD
Mailing Address - Street 2:101
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2209
Mailing Address - Country:US
Mailing Address - Phone:516-829-1028
Mailing Address - Fax:516-829-3530
Practice Address - Street 1:29 BARSTOW RD
Practice Address - Street 2:101
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2209
Practice Address - Country:US
Practice Address - Phone:516-829-1028
Practice Address - Fax:516-829-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01630666Medicaid
NYP42692Medicare PIN
NYP54351Medicare PIN
NY4845930001Medicare NSC