Provider Demographics
NPI:1679643209
Name:MOUNT ZION PODIATRY,P.C
Entity Type:Organization
Organization Name:MOUNT ZION PODIATRY,P.C
Other - Org Name:MOUNT ZION FOOT AND ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-385-2085
Mailing Address - Street 1:106 PENNSYLVANIA AVENUE SUITE 1
Mailing Address - Street 2:1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-2427
Mailing Address - Country:US
Mailing Address - Phone:718-385-2085
Mailing Address - Fax:718-385-5447
Practice Address - Street 1:106 PENNSYLVANIA AVENUE SUITE 1
Practice Address - Street 2:1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2427
Practice Address - Country:US
Practice Address - Phone:718-385-2085
Practice Address - Fax:718-385-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01430542Medicaid
NMP59541Medicare ID - Type UnspecifiedMEDICARE
NY01430542Medicaid
NYPQWQ81Medicare PIN