Provider Demographics
NPI:1700023843
Name:TRI STATE FOOT CARE, P.C
Entity Type:Organization
Organization Name:TRI STATE FOOT CARE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VASILIOS
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:SPYROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:8664-641-1065
Mailing Address - Street 1:9016 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1530
Mailing Address - Country:US
Mailing Address - Phone:866-464-1065
Mailing Address - Fax:877-464-1065
Practice Address - Street 1:13 S SHORE DR
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-3433
Practice Address - Country:US
Practice Address - Phone:866-464-1065
Practice Address - Fax:877-464-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005668213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04678OtherMEDICARE ID NUMBER
NY02180183Medicaid
NY04678OtherMEDICARE ID NUMBER
NY4448050003Medicare NSC