Provider Demographics
NPI:1811199326
Name:ASTORIA ADVANCED FOOT CARE
Entity Type:Organization
Organization Name:ASTORIA ADVANCED FOOT CARE
Other - Org Name:GRAND CENTRAL PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIS
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:HANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-682-3338
Mailing Address - Street 1:501 5TH AVE RM 1108
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-7880
Mailing Address - Country:US
Mailing Address - Phone:212-682-3338
Mailing Address - Fax:212-682-3335
Practice Address - Street 1:501 5TH AVE RM 1108
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-7880
Practice Address - Country:US
Practice Address - Phone:212-682-3338
Practice Address - Fax:212-682-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004560302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
01309AMedicare ID - Type Unspecified