Provider Demographics
NPI:1659304194
Name:NESTER PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:NESTER PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:NESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-759-1984
Mailing Address - Street 1:3 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 WALNUT RD
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2226
Practice Address - Country:US
Practice Address - Phone:516-674-9661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005515213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDE5960OtherMEDICARE RAILROAD
NYPLW021Medicare PIN
NYDE5960OtherMEDICARE RAILROAD