Provider Demographics
NPI:1629272695
Name:GRANITE STATE PODIATRY ASSOCIATES PA
Entity Type:Organization
Organization Name:GRANITE STATE PODIATRY ASSOCIATES PA
Other - Org Name:EXETER PODIATRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-668-3509
Mailing Address - Street 1:424 HANOVER STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104
Mailing Address - Country:US
Mailing Address - Phone:603-668-3509
Mailing Address - Fax:603-641-8442
Practice Address - Street 1:424 HANOVER STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-668-3509
Practice Address - Fax:603-641-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213ES0103X
NH0139332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5291500001Medicare NSC
NHRE7606Medicare PIN