Provider Demographics
NPI:1689925166
Name:EASTSIDE PODIATRY ASSOCIATES, PC
Entity Type:Organization
Organization Name:EASTSIDE PODIATRY ASSOCIATES, PC
Other - Org Name:LENOX HILL PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AFSANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIFI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-472-8872
Mailing Address - Street 1:210 EAST 68TH STREET
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6024
Mailing Address - Country:US
Mailing Address - Phone:212-472-8872
Mailing Address - Fax:212-472-8873
Practice Address - Street 1:210 EAST 68TH STREET
Practice Address - Street 2:SUITE 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6024
Practice Address - Country:US
Practice Address - Phone:212-472-8872
Practice Address - Fax:212-472-8873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3866213ES0131X
NYN5286213ES0131X
NYN005286213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty