Provider Demographics
NPI:1811187479
Name:PODIATRY ASSOCIATES OF NEW YORK PC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF KNOWLEDGE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-981-0100
Mailing Address - Street 1:401 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1927
Mailing Address - Country:US
Mailing Address - Phone:718-981-0100
Mailing Address - Fax:718-351-3215
Practice Address - Street 1:2338 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2346
Practice Address - Country:US
Practice Address - Phone:718-981-0100
Practice Address - Fax:718-351-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6159800001Medicare NSC
NYA100052412Medicare PIN