Provider Demographics
NPI:1649418567
Name:KEYSTONE PODIATRY
Entity Type:Organization
Organization Name:KEYSTONE PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTAGENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-931-9058
Mailing Address - Street 1:3040 E TREMONT AVE RM 101
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5733
Mailing Address - Country:US
Mailing Address - Phone:718-931-9058
Mailing Address - Fax:718-918-0004
Practice Address - Street 1:3040 E TREMONT AVE RM 101
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5733
Practice Address - Country:US
Practice Address - Phone:718-931-9058
Practice Address - Fax:718-918-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003843-1213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT93432Medicare UPIN
NYP39591Medicare PIN