Provider Demographics
NPI:1821130634
Name:ADVANCE PODIATRY PC
Entity Type:Organization
Organization Name:ADVANCE PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:
Authorized Official - First Name:ISAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BADALOV
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-239-5670
Mailing Address - Street 1:14425 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3129
Mailing Address - Country:US
Mailing Address - Phone:917-239-5670
Mailing Address - Fax:
Practice Address - Street 1:14425 77TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3129
Practice Address - Country:US
Practice Address - Phone:917-239-5670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006202213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty