Provider Demographics
NPI:1689455818
Name:PODIATRY OF GREAT NECK
Entity Type:Organization
Organization Name:PODIATRY OF GREAT NECK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-867-3504
Mailing Address - Street 1:9413 FLATLANDS AVE STE 201W
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3718
Mailing Address - Country:US
Mailing Address - Phone:310-867-3504
Mailing Address - Fax:
Practice Address - Street 1:9413 FLATLANDS AVE STE 201W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3718
Practice Address - Country:US
Practice Address - Phone:310-867-3504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty