Provider Demographics
NPI:1710583901
Name:STAND UP PODIATRY PLLC
Entity Type:Organization
Organization Name:STAND UP PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-680-8881
Mailing Address - Street 1:837 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3611
Mailing Address - Country:US
Mailing Address - Phone:718-680-8881
Mailing Address - Fax:718-680-7880
Practice Address - Street 1:837 59TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3611
Practice Address - Country:US
Practice Address - Phone:718-680-8881
Practice Address - Fax:718-680-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty