Provider Demographics
NPI:1750317715
Name:MEGDANIS, ERNEST G (DPM)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:G
Last Name:MEGDANIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8407 15TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228
Mailing Address - Country:US
Mailing Address - Phone:718-921-2156
Mailing Address - Fax:718-921-9536
Practice Address - Street 1:8407 15TH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228
Practice Address - Country:US
Practice Address - Phone:718-921-2156
Practice Address - Fax:718-921-2156
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004898213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01992350Medicaid
U34886Medicare UPIN
NYPA3381Medicare PIN